摘要
目的探讨根治性膀胱切除术围手术期并发症的发生情况并进行分类。方法回顾性分析1996年1月至2008年12月233例根治性膀胱切除的资料，男性200例，女性33例。平均年龄58．9岁（24～79）岁。采用改良Clavien分级系统将根治性膀胱切除术围手术期并发症进行分类。围手术期并发症定义为手术30d内发生的并发症。结果233例平均手术时间（339±84）min，平均失血量（818±756）ml。84例（36．1％）发生1种或1种以上的并发症，其中5例术中并发症。按改良Clavien分级分类，发生1～2级并发症65例，3～4级并发症19例，5级并发症0例。主要包括胃肠道并发症37例（15．9％），切口相关并发症34例（15．0％），肺部感染11例（4．7％）。多因素分析表明低蛋白血症增加术后并发症的发生率（OR=2．963，95％C1：1．451～6．050，P=0．003），而美国麻醉协会评分是影响术后Clavien3～5级并发症的独立因素（OR=2．520，95％CI：1．003-6．332，P=0．049）。结论根治性膀胱切除仍有较高的并发症发生率，低蛋白血症增加术后并发症的发生，而美国麻醉协会评分是影响术后Clavien3～5级并发症的重要因素。采用改良Clavien分级系统有助于分类管理并发症。
Objectives To analyze the perioperative complications of radical eystectomy using a standardized reporting methodology. Methods The clinical data of 233 cases of radical cysteetomy from January 1996 to December 2008 were reviewed. Two hundred male patients and 33 female patients were included. The mean age was 58.9 years old. All complications within 30 days of surgery were recorded and classified using a 5-grade modification of the Clavien system. Results Overall mean operative time was 339 （170-610） minutes, and mean blood loss was 818 （range 100 to 3500） ml. Of the 233 subjects at least 1 postoperative complication developed in 84 （36. 1% ）, including five cases of intraoperative complications. According to the modified Clavien system, 27 patients （ 11.6% ） had grade 1, 38（ 16. 3% ） had grade 2, 16（6. 9% ） had grade 3, and 3 （ 1.7% ） had grade 4 complications. The most frequent complication was gastrointestinal complications （ 15.9% ）, then the incision-related complications （ 15.0% ） and lung infections （4. 7% ）. An association between hypoproteinemia and any complication was found after adjusting for confounding variables （ OR = 2. 963, 95% CI： 1. 451-6. 050, P = 0. 003 ） , and American society of anesthesia score （ASA score） was significantly associated with any major complication （OR = 2. 520, 95% CI： 1. 003-6. 332, P = 0. 049 ）. Conclusions Radical cystectomy is associated with a high perioperative comlications, using the modification of the Clavien system has allowed us to stratify complications during radical cystectomy. Hypoproteinemia is independently associated with any complication in these patients and ASA score was significantly associated with any major complication.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2012年第10期902-904,共3页
Chinese Journal of Surgery
关键词
膀胱肿瘤
膀胱切除术
手术中并发症
手术后并发症
Urinary bladder neoplasms
Cystectomy
Intraoperative complications
Postoperative complications
