结肠癌根治术后并发症的Clavien-Dindo分级及其危险因素分析  

Clavien-Dindo classification and risk factors of postoperative complications of radical resection for colon cancer

作　　者：周晓峰[1] 杜华劲[1] 高学健[1] 王仔平[1] ZHOU Xiao-feng;DU Hua-jin;GAO Xue-jian;WANG Zi-ping(Department of General Surgery,First People′s Hospital of Chuzhou City,Chuzhou Anhui 239000,China)

机构地区：[1]滁州市第一人民医院普外科,安徽滁州239000

出　　处：《局解手术学杂志》2020年第7期553-557,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨导致结肠癌根治术后并发症发生的危险因素及其与Clavien-Dindo分级的关系。方法回顾性分析2016年10月至2018年10月我院收治的60例行结肠癌根治术患者的临床资料,统计其术后并发症情况,并进行Clavien-Dindo分级。根据有无并发症将患者分为发生组和未发生组,应用单因素和多因素Logistic回归分析法明确导致术后并发症发生的危险因素,并分析危险因素与Clavien-Dindo分级的关系。结果结肠癌根治术后并发症发生率为25.00%,Clavien-Dindo分级为Ⅰ级、Ⅱ级、Ⅲa级、Ⅲb级、Ⅳ级患者的并发症发生率分别为3.33%、11.67%、3.33%、3.33%、3.33%;发生组和未发生组患者性别、年龄、BMI、术前WBC、术前Hb、合并高血压、合并冠心病、术后造瘘、手术部位比较,差异无统计学意义(P>0.05);发生组ASAⅢ~Ⅳ级、APACHE-Ⅱ≥14分、合并糖尿病、TNMⅢ~Ⅳ期、肿瘤低分化、开腹根治术、手术时间≥150 min患者构成比均高于未发生组,差异有统计学意义(P<0.05),且经Logistic回归分析证实上述指标均是导致术后并发症发生的独立危险因素(P<0.05);不同ASA分级、不同APACHE-Ⅱ评分、不同TNM分期、不同手术方式、不同手术时间、不同肿瘤分化程度、是否合并糖尿病患者行结肠癌根治术后并发症的Clavien-Dindo分级比较,差异均有统计学意义(P<0.05)。结论结肠癌根治术后并发症Clavien-Dindo分级主要为Ⅱ级,导致术后并发症发生的危险因素包括ASAⅢ~Ⅳ级、APACHE-Ⅱ≥14分、合并糖尿病、TNMⅢ~Ⅳ期、肿瘤低分化、开腹根治术、手术时间≥150 min,且危险因素影响术后并发症Clavien-Dindo分级。Objective To investigate the risk factors of postoperative complications of radical resection for colon cancer and its relationship with Clavien-Dindo classification.Methods The clinical data of 60 patients who underwent radical resection for colon cancer in our hospital from October 2016 to October 2018 were retrospectively analyzed,of whom the postoperative complications were counted and classified by using Clavien-Dindo classification.Patients were divided into the occurrence group and the non-occurrence group according to the presence or absence of complications.Univariate and multivariate Logistic regression analysis were used to identify the risk factors leading to postoperative complications,and the relationship between risk factors and Clavien-Dindo classification was analyzed.Results The incidence of complications after radical resection for colon cancer was 25.00%,and the incidences of complications of Clavien-Dindo gradeⅠ,Ⅱ,Ⅲa,Ⅲb,Ⅳwere 3.33%,11.67%,3.33%,3.33%,and 3.33%,respectively.There was no significant difference in the composition ratio of gender,age,BMI,preoperative WBC,preoperative Hb,combined hypertension,colostomy,combined coronary heart disease and surgical site of patients between the occurence group and the non-occurrence group(P>0.05).The composition ratios of patients with ASA gradeⅢandⅣ,APACHE-Ⅱ≥14,diabetes mellitus,TNMⅢtoⅣ,poor tumor differentiation,open radical surgery and operation time≥150 minutes in the occurrence group were higher than those in the non-occurrence group,the differences were significant(P<0.05),and which were confirmed as independent risk factors for postoperative complications by Logistic regression analysis(P<0.05).There were significant differences in Clavien-Dindo classification of complications after colorectal surgery between the patients with different ASA grades,APACHE-Ⅱscores,TNM stages,surgical approaches,operation time,tumor differentiation degree,whether to incorporate diabetes(P<0.05).Conclusion The Clavien-Dindo classification

关 键 词：结肠癌根治术 并发症 Clavien-Dindo分级 危险因素 

分 类 号：R735.32[医药卫生—肿瘤]