综合并发症指数在铥激光前列腺剜除术后患者中的应用

doi:10.19558/j.cnki.10-1020/r.2022.01.012

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (833 KB) RICH HTML
输出: BibTeX | EndNote (RIS)

摘要 目的： 评估综合并发症指数（CCI）在铥激光前列腺剜除术（ThuLEP）术后并发症评估中的应用,并将其与Clavien-Dindo(CDC)分级系统进行对比。方法： 回顾性分析2019年8月至2021年10月北京清华长庚医院泌尿外科因良性前列腺增生行ThuLEP手术的283例住院患者的临床资料,分别使用CDC和CCI两种并发症评价体系对患者术后并发症进行评估,并分析两者与术后住院时间的相关性。结果： 73例（25.60%）患者共出现80次并发症。CDC分级结果显示Ⅰ级并发症59例（20.85%）,Ⅱ级13例（4.59%）,Ⅲa级4例（1.41%）,Ⅲb级3例（1.06%）,Ⅳa级1例（0.35%）,无Ⅳb级和V级并发症发生。存在并发症患者累积CCI分值的中位数为8.7（8.7,33.7）分,7例患者发生≥2种并发症,其累积CCI分值高于CDC最高分级对应的CCI分值。两者均与术后住院时间显著正相关,即CDC分级越高,术后住院时间越长（r=0.34,P<0.001）,累积CCI分值越高,术后住院时间也越长（r=0.58,P<0.001）。累积CCI分值与术后住院时间相关相关性更强。结论： CCI适用于ThuLEP术后短期并发症的评估,对比CDC可以更加准确地反映并发症的数量和对术后住院时间的影响。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	宋海峰
	付猛
	白文洁
	李建兴

关键词 ：前列腺, 手术后并发症, 铥激光

Abstract：Objective： To evaluate the use of the comprehensive complication index （CCI） in the evaluation of postoperative complications after thulium laser enucleation of the prostate （ThuLEP） and compare CCI with the Clavien-Dindo classification（CDC） grading system. Methods： The clinical data of 283 patients who underwent ThuLEP for benign prostatic hyperplasia （BPH） in the Department of Urology of Beijing Tsinghua Chang Gung Memorial Hospital from August 2019 to October 2021 were retrospectively analyzed. Patients were assessed for postoperative complications using the CDC and CCI complication evaluation systems respectively, and the correlation between the two and postoperative length of stay was analysed. Results： A total of 80 complications occurred in 73 patients （25.60%）. The results of CDC classification showed grade I complications in 59 cases （20.85%）, grade Ⅱ in 13 cases （4.59%）, grade IIIA in 4 cases （1.41%）, grade IIIB in 3 cases （1.06%）, and grade IVA in 1 case （0.35%）. No grade IVB or V complications occurred. The median cumulative CCI score for patients with complications was 8.7（8.7,33.7）. A total of 7 patients had ≥ 2 complications, and the cumulative CCI score was higher than the CCI score corresponding to the highest grade of CDC. Both of them were positively correlated with postoperative hospital stay, i.e. higher CDC grade, longer postoperative hospital stay （r=0.34, P<0.001）, higher cumulative CCI score, and longer postoperative hospital stay （r=0.58, P<0.001）. Cumulative CCI scores were more strongly correlated with postoperative hospital stay. Conclusion： Compared with CDC, CCI can be used more accurately to assess complications andtheir influence on postoperative hospital stay after ThuLEP.

Key words： prostate post-operative complications thulium laser

收稿日期: 2021-12-28

通讯作者: 李建兴,ljx1@163.com

引用本文:

宋海峰, 付猛, 白文洁, 李建兴. 综合并发症指数在铥激光前列腺剜除术后患者中的应用[J]. 微创泌尿外科杂志, 2022, 11(1): 47-51.
Song Haifeng, Fu Meng, Bai Wenjie, Li Jianxing. Comprehensive Complication Index in Thulium Laser Enucleation of Prostate. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(1): 47-51.

链接本文:

http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1741.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2022/V11/I1/47

[1] CHEN YB, CHEN Q, WANG Z, et al. A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with Holmium laser enucleation of the prostate based on a 2-year followup[J]. J Urol,2013,189(1):217-222.
[2] DINDO D, DEMARTINES N, CLAVIEN PA. Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg,2004,240(2):205-213.
[3] WESTHOFEN T, SCHOTT M, KELLER P, et al. Superiority of Holmium laser enucleation of the prostate over transurethral resection of the prostate in a matched-pair analysis of bleeding complications under various antithrombotic regimens[J]. J Endourol,2021,35(3):328-334.
[4] CHANG CH, LIN TP, Huang JY. Safety and effectiveness of high-power Thulium laser enucleation of the prostate in patients with glands larger than 80 mL[J]. BMC Urol,2019,19(1):8.
[5] WALDBILLIG F, NIENTIEDT M, KOWALEWSKI KF, et al. The comprehensive complication index for advanced monitoring of complications following endoscopic surgery of the lower urinary tract[J]. J Endourol,2021,35(4):490-496.
[6] SLANKAMENAC K, GRAF R, BARKUN J, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity[J]. Ann Surg,2013,258(1):1-7.
[7] CLAVIEN PA, VETTER D, STAIGER RD, et al. The comprehensive complication index(CCI(R)):added value and clinical perspectives 3 years"Down the Line[J]. Ann Surg,2017,265(6):1045-1050.
[8] SLANKAMENAC K, NEDERLOF N, PESSAUX P, et al. The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials[J]. Ann Surg,2014,260(5):757-762; discussion 762-763.
[9] GU FL, XIA TL, KONG XT. Preliminary study of the frequency of benign prostatic hyperplasia and prostatic cancer in China[J]. Urology,1994,44(5):688-691.
[10] LAN Y, WU W, LIU L, et al. Thulium (Tm:YAG) laser vaporesection of prostate and bipolar transurethral resection of prostate in patients with benign prostate hyperplasia: a systematic review and meta-analysis[J]. Lasers Med Sci,2018,33(7):1411-1421.
[11] HARTUNG FO, KOWALEWSKI KF, VON HJ, et al. Holmium versus Thulium laser enucleation of the prostate: a systematic review and meta-analysis of randomized controlled trials[J]. Eur Urol Focus,2021,(21):S2405-4569.
[12] MITROPOULOS D, ARTIBANI W, BIYANI CS, et al. Validation of the Clavien-Dindo grading system in urology by the European association of urology guidelines Ad Hoc panel[J]. Eur Urol Focus,2018,4(4):608-613.
[13] YOON PD, CHALASANI V, WOO HH. Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures: analysis of 2010 to 2012[J]. J Urol,2013,190(4):1271-1274.
[14] KOWALEWSKI KF, MÜLLER D, MÜHLBAUER J, et al. The comprehensive complication index (CCI):proposal of a new reporting standard for complications in major urological surgery[J]. World J Urol,2021,39(5):1631-1639.
[15] KIM TH, SUH YS, HUH YJ, et al. The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien-Dindo classification in radical gastric cancer surgery[J]. Gastric Cancer,2018,21(1):171-181.
[16] KIM SH, HWANG HK, LEE WJ, et al. Comprehensive complication index or Clavien-Dindo classification: which is better for evaluating the severity of postoperative complications following pancreatectomy[J]? World J Surg,2021,45(3):849-856.
[17] TAMINI N, BERNASCONI D, RIPAMONTI L, et al. Clinical validation of the comprehensive complication index in colon cancer surgery[J]. Cancers (Basel),2021,13(7):1745.
[18] LAI Q, MELANDRO F, NOWAK G, et al. The role of the comprehensive complication index for the prediction of survival after liver transplantation[J]. Updates Surg,2021,73(1):209-221.
[19] VETTERLEIN MW, KLEMM J, GILD P, et al. Improving estimates of perioperative morbidity after radical cystectomy using the European association of urology quality criteria for standardized reporting and introducing the comprehensive complication index[J]. Eur Urol,2020,77(1):55-65.
[20] HAAS M, HUBER T, PICKL C, et al. The comprehensive complication index is associated with a significant increase in complication severity between 30 and 90 days after radical cystectomy for bladder cancer[J]. Eur J Surg Oncol,2021,47(5):1163-1171.
[21] GRÜNE B, KOWALEWKSI KF, WALDBILLIG F, et al. The comprehensive complication index (CCI) for improved reporting of complications in endourological stone treatment[J]. Urolithiasis,2021,49(3):269-279.
[22] GEIGER S, KOCHER N, ILLINSKY D, et al. Comparison of the comprehensive complication index and Clavien-Dindo systems in predicting perioperative outcomes following radical nephroureterectomy[J]. Transl Androl Urol,2020,9(4):1780-1785.