CAJ | 학술논문

目的探讨根治性膀胱切除术围手术期并发症的发生情况并进行分类.方法回顾性分析1996年1月至2008年12月233例根治性膀胱切除的资料,男性200例,女性33例.平均年龄58.9岁(24 ～79)岁.采用改良Clavien分级系统将根治性膀胱切除术围手术期并发症进行分类.围手术期并发症定义为手术30 d内发生的并发症.结果 233例平均手术时间(339 ± 84) min,平均失血量(818±756)ml.84例(36.1％)发生1种或1种以上的并发症,其中5例术中并发症.按改良Clavien分级分类,发生1～2级并发症65例,3～4级并发症19例,5级并发症0例.主要包括胃肠道并发症37例(15.9％),切口相关并发症34例(15.0％),肺部感染11例(4.7％).多因素分析表明低蛋白血症增加术后并发症的发生率(OR =2.963,95％CI:1.451 ～6.050,P=0.003),而美国麻醉协会评分是影响术后Clavien 3 ～5级并发症的独立因素(OR=2.520,95％ CI:1.003～6.332,P=0.049).结论根治性膀胱切除仍有较高的并发症发生率,低蛋白血症增加术后并发症的发生,而美国麻醉协会评分是影响术后Clavien 3 ～5级并发症的重要因素.采用改良Clavien分级系统有助于分类管理并发症.
목적 탐토근치성방광절제술위수술기병발증적발생정황병진행분류.방법 회고성분석1996년1월지2008년12월233례근치성방광절제적자료,남성200례,녀성33례.평균년령58.9세(24 ～79)세.채용개량Clavien분급계통장근치성방광절제술위수술기병발증진행분류.위수술기병발증정의위수술30 d내발생적병발증.결과 233례평균수술시간(339 ± 84) min,평균실혈량(818±756)ml.84례(36.1％)발생1충혹1충이상적병발증,기중5례술중병발증.안개량Clavien분급분류,발생1～2급병발증65례,3～4급병발증19례,5급병발증0례.주요포괄위장도병발증37례(15.9％),절구상관병발증34례(15.0％),폐부감염11례(4.7％).다인소분석표명저단백혈증증가술후병발증적발생솔(OR =2.963,95％CI:1.451 ～6.050,P=0.003),이미국마취협회평분시영향술후Clavien 3 ～5급병발증적독립인소(OR=2.520,95％ CI:1.003～6.332,P=0.049).결론 근치성방광절제잉유교고적병발증발생솔,저단백혈증증가술후병발증적발생,이미국마취협회평분시영향술후Clavien 3 ～5급병발증적중요인소.채용개량Clavien분급계통유조우분류관리병발증.
Objectives To analyze the perioperative complications of radical cystectomy using a standardized reporting methodology.Methods The clinical data of 233 cases of radical cystectomy from January 1996 to December 2008 were reviewed. Two hundred male patients and 33 female patients were included.The mean age was 58.9 years old.All complications within 30 days of surgery were recorded and classified using a 5-grade modification of the Clavien system.Results Overall mean operative time was 339(170-610) minutes,and mean blood loss was 818 (range 100 to 3500) ml.Of the 233 subjects at least 1 postoperative complication developed in 84 (36.1％ ),including five cases of intraoperative complications.According to the modified Clavien system,27 patients ( 11.6％ ) had grade 1,38 ( 16.3％ ) had grade 2,16(6.9％ ) had grade 3,and 3 (1.7％) had grade 4 complications.The most frequent complication was gastrointestinal complications ( 15.9％ ), then the incision-related complications ( 15.0％ ) and lung infections (4.7％ ).An association between hypoproteinemia and any complication was found after adjusting for confounding variables ( OR =2.963,95％ CI: 1.451-6.050,P =0.003 ),and Anerican society of anesthesia score (ASA score) was significantly associated with any major complication (OR =2.520,95％CI:1.003-6.332,P =0.049).Conclusions Radical cystectomy is associated with a high perioperative comlications,using the modification of the Clavien system has allowed us to stratify complications during radical cystectomy.Hypoproteinemia is independently associated with any complication in these patients and ASA score was significantly associated with any major complication.