改良Clavien分级系统在经尿道前列腺等离子双极电切术围手术期并发症中的应用

Analysis of perioperative complications of plasma kinetic bipolar resection of the prostate

目的 采用改良的Clavien分级系统对经尿道前列腺等离子双极电切术（PKRP）围手术期的并发症进行回顾性分级.方法 对2013年1～12月间171例行PKRP的良性前列腺增生（BPH）患者的临床资料进行回顾性分析,依据前列腺体积将患者分为3组：＜40 mL（A组）、40～79 mL（B组）、≥80 mL（C组）,采用改良的Clavien分级系统对围手术期并发症进行分析.结果 住院期间,共有34例患者发生并发症43例次,总的并发症发生率为19.9％ （34/171）,其中并发症发生率A组为11.5％（3/26）、B组20.7％（18/87）、C组22.4％ （13/58）.3组间比较,差异无统计学意义（x2=1.405,P＞0-05）.43例次并发症中,Ⅰ级22例次、Ⅱ级16例次、Ⅲa级1例次、Ⅳa级3例次、Ⅳb级1例次,无Ⅲb级和Ⅴ级（死亡）并发症.结论 采用改良的Clavien分级系统,不需要处理或不需要介入治疗的ClavienⅠ、Ⅱ级并发症占绝大多数（88.4％）,而Clavien Ⅲ级（2.3％）及Clavien Ⅳ级（9.3％）并发症较少见,无Clavien Ⅴ级并发症.改良的Clavien分级系统是一种有效的方法,能成功地应用于PKRP术后并发症的分级.

Objective To retrospectively review and grade the perioperative complications of plasma kinetic bipolar resection of the prostate （PKRP） using modified Clavien classification system （MCCS）. Methods Clinical data of 171 benign prostate hyperplasia （BPH） patients who underwent PKRP during Jan. and Dec. 2013 were retrospectively analyzed. According to prostate size, patients were classified into three groups： prostate〈40 mL （group A）, 40-79 mL （group B）, andS80 mL （group C）. Complications were recorded using MCCS. Results The difference between the three groups was not statistically significant.in age, maximum urinary flow rate, postvoid residual urine, international prostate symptom score and quality of life （P〉0. 06）. During hospitalization, 43 complications occurred in 34 cases, with the total complication rate being 19.9% （34/ 171）. In detail, the incidence of complications was 11.5 % （3/26） in group A, 20.7% （3/26） in group B and 22.4 % （13/58） in group C （Z2 =1.405,P〉0-05）. Among these 43 complications, 22 were grade I , 16 were grade ]1 , 1 was grade Ilia, 3 were grade IV, and I was grade IV a. There were no grade I1[ b and V complications. Oonclusion Using the modified Clavien classi- fication system, grades I and II complications that require no noninterventional treatment constitute the majority of complications （88.4 %）, while grades Ill （2.3 %） and IV （9.3 % ） complications were less common and grade V complications were zero （0%）. The MCCS is a validated method that can be successfully used to grade complications following PKRP.