Clavien-Dindo分级和并发症综合指数在高龄肝癌肝切除术安全性评估中的应用

Application of Clavien-Dindo classification and comprehensive complication index in safety evaluation of hepatectomy for elderly patients with hepatocellular carcinoma

目的:探讨Clavien-Dindo分级和并发症综合指数(CCI)在高龄肝细胞癌(肝癌)肝切除患者安全性评估中的应用价值。方法:回顾性分析2013年8月至2019年8月南通大学附属南通第三医院行肝癌肝切除的96例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。根据年龄分为高龄组(≥70岁,35例)和对照组(<70岁,61例)。其中高龄组男29例,女6例;年龄70~82岁,中位年龄77岁;对照组男51例,女10例;年龄29~67岁,中位年龄43岁。分别采用Clavien-Dindo分级和CCI分析两组肝癌患者肝切除的并发症。两组患者围手术期数据比较采用t检验、秩和检验和χ^(2)检验。结果:高龄组合并高血压病、糖尿病分别为13、9例,对照组相应为5、4例,差异有统计学意义(χ^(2)=12.232,6.971;P<0.05)。两组患者均手术顺利,无发生围手术期死亡。高龄组和对照组手术时间中位数分别为300(240)、390(650)min,差异无统计学意义(Z=-0.835,P>0.05);平均术中出血量分别为(237±73)、(247±54)ml,差异无统计学意义(t=-0.791,P>0.05)。高龄组术后并发症Clavien-Dindo分级Ⅰ、Ⅱ、Ⅳ级分别为9、9、1例,对照组相应为14、16、1例,差异无统计学意义(Z=-0.279,P>0.05);CCI评分分别为(16±8)、(16±9)分,差异亦无统计学意义(t=-0.071,P>0.05)。结论:高龄肝癌肝切除术是安全的,Clavien-Dindo分级可指导危重患者处理,CCI可综合评估危险性,两者结合可更好地评估手术风险,避免严重并发症发生。

Objective To evaluate the application value of Clavien-Dindo classification and comprehensive complication index (CCI) in the safety assessment of hepatectomy in elderly patients with hepatocellular carcinoma (HCC).MethodsClinical data of 96 HCC patients who underwent hepatectomy in Affiliated Nantong Hospital 3 of Nantong University from August 2013 to August 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the elderly group (≥70 years, n=35) and control group(<70 years, n=61). In the elderly group, 29 patients were male and 6 female, aged from 70 to 82 years, with a median age of 77 years. In the control group, 51 cases were male and 10 female, aged from 29 to 67, with a median age of 43 years. The complications of hepatectomy in two groups were analyzed with Clavien-Dindo classification and CCI. Perioperative data between two groups were compared by t test, rank-sum test andChi-square test.ResultsIn the elderly group, 13 patients were complicated with hypertension and 9 cases of diabetes mellitus, and 5 and 4 correspondingly in the control group, where significant differences were observed (χ^(2)=12.232, 6.971;P<0.05). The surgeries in patients of both groups were completed successfully, and no perioperative death occurred. The median operation time in the elderly and control groups was 300(240) and 390(650) min, respectively, with no significant difference (Z=-0.835, P>0.05). The average intraoperative blood loss was (237±73) and (247±54) ml in the elderly and control groups, with no significant difference(t=-0.791, P>0.05). In the elderly group, 9 patients were classified as Clavien-Dindo grade Ⅰ, 9 cases of Clavien-Dindo grade Ⅱ and 1 case of Clavien-Dindo grade Ⅳ, and 14, 16 and 1 correspondingly in the control group, where no significant difference was observed (Z=-0.279, P>0.05). The CCI scores were 16±8 and 16±9 in the elderly and control groups, and no significant difference was observed (t=-0.071, P>0.05).ConclusionsIt is safe to perform hepatectomy in elderly patients with HCC. Clavien-Dindo classification can help to treat critically ill patients. CCI can comprehensively evaluate the risk. The combination of two indexes can better evaluate the surgical risk and decrease the incidence of severe complications.