三种腔镜前列腺切除手术并发症比较及Clavien-Dindo分级应用  

Application of Clavien-Dindo classification for comparing complications of three endoscopic procedures for benign prostatic hyperplasia

作　　者：蔡芳震[1] 陈朝虹[1] 张建育[1] 

机构地区：[1]福建医科大学附属第二医院泌尿外科,福建泉州362000

出　　处：《南方医科大学学报》2015年第9期1344-1348,共5页Journal of Southern Medical University

摘　　要：目的比较经尿道前列腺电切术(TURP)、双极等离子切除术(PKRP)及钬激光剜除术(Ho LEP)三种术式并发症差异,初步探讨Clavien-Dindo分级对3种术式并发症标准化评价的应用价值。方法 2010年1月至2013年12月在本院泌尿外科接受腔镜手术的前列腺增生患者625例按照术式分为3组:TURP(214例)、PKRP(207例)和Ho LEP(204例),分别统计3组各项并发症差异并纳入Clavien-Dindo分级进行比较。结果 3组患者一般资料比较差异无统计学意义(P>0.05),TURP组各项的并发症发生率总体上高于PKRP组和Ho LEP组,其中电解质失平衡、术中大量失血、尿路刺激症状、尿路堵塞、前列腺电切综合征、术后勃起功能障碍3组间差异有统计学意义(P<0.05)。按照Clavien-Dindo分级,Ⅱ级并发症比较,TURP组显著高于PKRP组和Ho LEP组(P<0.05);Ⅲ级和Ⅳ级并发症比较,TURP组显著高于Ho LEP组(P<0.05);Ⅰ级和Ⅴ级3组间差异无统计学意义(P>0.05)。结论各项并发症和Clavien-Dindo分级结果比较表明PKRP和Ho LEP并发症少,安全性高,值得临床推荐使用。Clavien-Dindo分级有利于手术并发症评价和比较的标准化,但还需要进一步完善和发展。Objective To compare the incidences of complications associated with 3 different endoscopic procedures, namely transurethral resection of prostate （TURP）, bipolar plasmakinetic resection of the prostate （PKRP）, and holmium laser enucleation of the prostate （HoLEP） in the treatment of benign prostatic hyperplasia （BPH） and assess the clinical value of the Clavien-Dindo classification system for standardizing the evaluation of the complications. Methods Between January 2010 and December 2013, a total of 625 patients with BPH scheduled for endoscopic surgery underwent TURP （214 cases）, PKRP （207 cases）, or HoLEP （204 cases）. The complications were recorded in each group and analyzed using the Clavien-Dindo classification system. Results There was no significant difference in the baseline data among the 3 groups （P〉0.05）. TURP was associated with a higher total incidence rate of complications than PKRP and HoLEP, and the incidences of electrolyte disturbance, massive intraoperative hemorrhage, urinary irritation symptom, urinary blockage, transurethral resection syndrome （TRUS）, and erectile dysfunction （ED） differed significantly among the 3 groups （P〈0.05）. According to Clavien-Dindo classification, the incidence of grade II complications was significantly higher in TURP group than in PKRP and HoLEP groups （P〈0.05）, and that of grades III and IV complications was significantly higher in TURP group than in HoLEP group （P〈0.05）; no significant difference was found in grade I or V complications among the 3 groups （P〉0.05）. Conclusion According to the results of Clavien-Dindo classification analysis, PKRP and HoLEP are associated with fewer complications with a better safety profile in the treatment of BPH. The current Clavien-Dindo classification system can contribute to standardized evaluation of surgical complications but still needs further modifications for better performance.

关 键 词：经尿道前列腺电切术 经尿道等离子切除术 钬激光剜除术 并发症 Clavien-Dindo分级 

分 类 号：R699.8[医药卫生—泌尿科学]