术前查尔森合并症权重指数评分与膀胱全切患者住院时间、早期并发症及治疗费用的研究

Research in length of stay, early complications and treatment cost in radical cystectomy patients with different Charlson Comorbidity Index score

目的 评估术前不同查尔森合并症权重指数（CCI）得分的膀胱癌患者根治性膀胱全切术后住院时间、早期并发症与治疗费用是否不同.方法 选取2012年3月至2014年8月,在云南省泌尿外科研究所就诊并符合要求的膀胱癌患者102例,按CCI得分不同将研究对象分为3个组：CCI=0或1分组69例,CCI=2分组19例,CCI≥3分组14例.按CCI评价术前合并症,术后按常规随访3个月.分析不同组别的患者住院天数、早期并发症与治疗总费用.结果 不同CCI得分组患者住院天数、早期并发症和治疗费用比较差异均有统计学意义,H值分别为20.722、6.025和7.047,P＜0.05.早期并发症方面,不同CCI得分组患者尿流改道相关早期并发症发生情况比较差异有统计学意义,日=7.100,P＜0.05,而非尿流改道相关并发症发生情况比较差异无统计学意义,H=2.590,P＞0.05.结论 CCI得分不同,患者住院天数、早期并发症发生率和治疗总费用也不同.CCI≥3分的膀胱全切术患者,特别是膀胱全切后选择原位尿流改道术的患者,有并发症发生率较高的可能.术前应规范评估患者合并症,并将合并症纳入患者选择考虑范围.

Objective To assess the length of stay,early complication and cost of treatment in radical cystectomy （RC） patients with different Charlson Comorbidity Index Score （CCI）.Methods A prospective study of a total of 102 patients who underwent RC between March 2012 and August 2014 in Center for Research of Urology in Yunnan Province,China.They were divided into three groups：69 cases in CCI=0 or 1group,19 cases in CCI=2 group,14 cases in CCI≥3 group.Comorbidities were graded according to CCI,and each patient was followed-up for 3 months after RC.Length of stay,early complications and treatment cost were analyzed by statistics.Results A total of 102 patients were analyzed.There were obvious differences with respect to length of stay,early complication and cost of treatment comparing patients in each CCI group,H=20.722,6.025,and 7.047,P〈0.05.The incidence of diversion-related early complications in patients with different CCI showed significant difference,H=7.100,P〈0.05,however,the non diversionrelated early complications did not show significant difference between patients with different CCI,H=2.590,P〉0.05.Conclusions Patients with different CCI showed difference in the length of stay,early complication and cost of treatment in RC patients with different CCI.CCI≥3 might help to identify patients at risk for early complications after RC,especially in the orthotopic urinary diversion operation.Patients＇ complication should be evaluated standardized before operation and these should be included in patients＇ consideration.