Clavien-Dindo分级系统在微创经皮肾镜取石术并发症评价中的应用研究

Application of Clavien-Dindo Classification System to complications of minimally-invasive percutaneous nephrolithotomy

摘要:

目的  探讨Clavien-Dindo分级系统在微创经皮肾镜取石术围手术期并发症评价中的应用价值。方法  回顾性研究2013年1月-2015年10月行微创经皮肾镜取石术（MPCNL）治疗的377例上尿路结石患者的临床资料，按照Clavien-Dindo分级系统对围手术期并发症进行分级并作统计学分析。将所有肾结石患者按肾脏解剖学结构、结石复杂程度及是否伴随基础疾病进行分组，并比较各组对分级结果的影响。结果  该研究共纳入377例行MPCNL的肾结石患者，发生围手术期并发症85例（22.5%），其中Ⅰ级并发症23例（6.1%），Ⅱ级38例（10.1%），Ⅲa级14例（3.7%），Ⅲb级5例（1.3%），Ⅳa级2例（0.5%），Ⅳb级2例（0.5%），Ⅴ级1例（0.3%）。在肾脏解剖结构组分析发现，解剖结构异常组Ⅰ～Ⅳ级并发症发生率高于正常组（P <0.05）；在结石复杂程度组分析发现，复杂结石组Ⅱ、Ⅲ级并发症发生率高于简单结石组（P <0.05）；在是否伴基础疾病组分析发现，伴基础疾病组Ⅰ、Ⅱ级并发症发生率高于无基础疾病组（P <0.05）。结论  Clavien-Dindo分级系统能够标准化评价MPCNL围手术期并发症，并可应用于手术风险评估。

Abstract:

Objective To evaluate the Clavien-Dindo Classification System (CDCS) in assessment of perioperative complications in minimally-invasive percutaneous nephrolithotomy (MPCNL). Methods Clinical data of 377 patients with upper urinary stones who underwent MPCNL from January 2013 to October 2015 were retrospectively analyzed. Complications were recorded and graded using CDCS. The patients were divided into three groups according to kidney anatomy, stone burden and underlying diseases. The complications were recorded in the three groups and analyzed using the CDCS. Results Of the 377 patients 85 (22.5%) cases had perioperative complications; evaluated by CDCS, gradⅠ, Ⅱ, Ⅲa, Ⅲb, Ⅳa, Ⅳb and Ⅴ complications occurred in 23 cases (6.1%), 38 cases (10.1%), 14 cases (3.7%), 5 cases (1.3%), 2 cases (0.5%), 2 cases (0.5%) and 1 cases (0.3%), respectively. According to CDCS, the incidences of grade Ⅰ, Ⅱ, Ⅲ and Ⅳ complications in the abnormal anatomy group were significantly higher than those in the normal anatomy group (P < 0.05). The incidences of grade Ⅱ and Ⅲ complications were significantly higher in the complex stone group than in the simple stone group (P < 0.05). The incidences of grade Ⅰ and Ⅱ complications were significantly higher in the underlying disease group than in the group without underlying disease (P < 0.05). Conclusions The Clavien-Dindo Classification System can not only standardize evaluation of perioperative complications but also be applied to surgical risk assessment.