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食管癌根治术后并发症clavien-dindo分级≥Ⅲ级的危险因素分析

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食管癌根治术后并发症Clavien-Dindo分级≥Ⅲ级的危险因素分析

作者：丁钎州河南大学

学位级别：硕士

背景:最新流行病学结果示,食管癌的全球发病率排名位居第八,总体死亡率排名位居第六,在全球范围内,2020年估计有60.41万例食管癌新发病例和54.41万例死亡,中国作为食管癌的高发地区,2020年间中国新增食管癌病例数高达32.4万例。虽然食... 详细信息

背景:最新流行病学结果示,食管癌的全球发病率排名位居第八,总体死亡率排名位居第六,在全球范围内,2020年估计有60.41万例食管癌新发病例和54.41万例死亡,中国作为食管癌的高发地区,2020年间中国新增食管癌病例数高达32.4万例。虽然食管癌目前的治疗手段多样化,包括放疗、化疗、靶向及免疫治疗,同时倡导多学科一体的综合治疗理念,但食管癌最佳的治疗方式依旧首选手术,尽管手术方式不断精进及手术技术在不断提高,食管癌根治术依旧是具有高度侵入性和复杂性的外科手术之一,其围手术期并发症的发生和病死风险依旧较高,同时目前国内外更多的是关注某一并发症的危险因素分析,对于食管癌术后所有并发症综合评估的研究较少,且国内长期以来缺乏对于术后并发症统一评估的标准,这不利于不同中心数据的比较和医疗质量的改进。clavien-dindo分级作为国际通用的并发症分级系统,可用于食管癌术后并发症的严重程度分级,这是一种客观、整体而又全面的术后并发症分级系统,本研究将依食管癌术后并发症治疗方法为导向,参照clavien-dindo分级系统,对术后并发症进行量化分级,探讨食管癌根治术后并发症clavien-dindo分级≥Ⅲ级的危险因素。目的:本研究旨在通过并发症clavien-dindo分级系统,探讨食管癌根治术后并发症clavien-dindo分级≥Ⅲ级的危险因素,从而对食管癌手术患者进行围手术期个体化干预,降低食管癌患者围手术期并发症的发生率及严重程度。方法:收集2018年1月至2022年12月河南大学第一附属医院胸外科收治的121名食管癌根治术患者的临床资料,其中男、女性患者分别为84例、37例,以食管癌患者术后并发症治疗手段为导向,采用clavien-dindo分级系统,将食管癌术后并发症进行量化分级,根据并发症严重程度,将患者分为两组(clavien-dindo分级clavien-dindo分级≥Ⅲ级发生的因素进行单因素分析,对于单因素有意义的危险因素进一步行多因素分析,探究导致≥Ⅲ级并发症发生的独立危险因素。结果:1.单因素分析结果提示,患者的性别(P=0.504)、年龄(P=0.218)、长期大量吸烟(吸烟指数≥400支*年)(P=0.6)、饮酒史(P=0.577)、BMI(P=0.712)、心血管疾病(P=0.808)、糖尿病史(P=0.358)、肿瘤部位(P=0.362)、临床分期(P=0.656)、术前新辅助治疗(P=0.302)、Charlson指数(P=0.885)、NRS-2002营养风险筛查评分(P=0.94)、NLR(P=0.081)及SII(P=0.198)指标,在并发症clavien-dindo分级0.05)。2.脑血管疾病史(P=0.02)、PNI(P=0.002)、ASA分级(P=0.017)、手术时间(P=0.001)及术中出血量(P=0.005)在并发症clavien-dindo分级Ⅱ级(0R=3.730,95%CI1.211-11.492,P=0.022)、低PNI(0R=0.867,95%CI 0.780-0.964,P=0.008)、手术时间(0R=1.018,95%CI 1.003-1.034,P=0.016)对患者并发症clavien-dindo分级≥Ⅲ级的发生有影响,为其独立危险因素。结论:手术用时越长、ASA分级>Ⅱ级、术前低PNI会增加食管癌患者术后并发症clavien-dindo分级≥Ⅲ级的发生率,其中以中-大量胸腔积液常见。

关键词：食管癌 clavien-dindo ASA PNI 并发症

clavien-dindo classification and risk factors of complications after pancreaticoduodenectomy

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Discussion of Clinical Cases 2018年第3期5卷 13-17页

作者： Xiaoming Zou Zhelin Yun Shengbin Zhang Jin Zhao Bing Li Department of General Surgery The Third Affiliated Hospital of Inner Mongolia Medical UniversityBaotouChina

Objective: To analyze clavien-dindo classification and risk factors of complications after pancreaticoduodenectomy and inves-tigate the relationship between the major risk factors and clavien-dindo classification of complications. Methods: The retrospective case-control study was adopted. The clinical data of 200 patients who underwent pancreatico-duodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected. The patients underwent Whipple procedure or pylorus-preserving pancreaticoduodenectomy according to the tumor site. Observation indicators included: (1) postoperative complications using clavien-dindo classification;(2) univariate and multivariate analyses: patients' basic information, surgery-related factors, pancreas-related factors;(3) relationship between independent risk factors and clavien-dindo classification of complications after pancreaticoduodenectomy. The chi-square test was applied to univariate analysis and categorical data. The comparison between groups was done by using independent samples nonparametric test (Kolmogorov-Smirnov Z), and multivariate analysis was done by using Logistic regression model. Results: (1) Postoperative complications: Of 200 patients, 122 underwent Whipple procedure and 78 underwent pylorus-preserving pancreaticoduodenectomy, including 6 cases combined with vascular reconstructions and 1 case with RFA of liver tumors. Ninety-eight patients had postoperative complications, including 41 patients with no less than 2 types of complications. After surgery, pancreatic fistula was detected in 80 patients, including 42 cases with grade A, 28 cases with grade B and 10 cases with grade C;incisional infection in 29 patients;gastric retention in 24 patients;intra-abdominal infection in 16 patients;intra-abdominal hemorrhage in 10 patients, including 8 patients receiving interventional treatment;biliary leakage in 7 patients and unplanned reoperation in 2 patients. Three patients were dead during hospitalization. T

关键词： Pancreatic diseases Pancreaticoduodenectomy Surgical procedures Post-operative complications Risk factors clavien-dindo classification

Reliability of nephrolithometric nomograms in patients treated with minimally invasive percutaneous nephrolithotomy: A precision study

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Asian Journal of Urology 2023年第1期10卷 70-80页

作者： Giorgio Mazzon Francesco Claps Nicola Pavan Simon Choong Guohua Zeng Wenqi Wu Jiehui Zhong Maida Bada Marco Pirozzi Raffaele Vitale Antonio Celia Department of Urology San Bassiano HospitalBassano del GrappaItaly Department of Urology University of TriesteTriesteItaly Institute of Urology University College Hospitals LondonLondonUK Department of Urology Minimally Invasive Centrethe first affiliated hospital of Guangzhou Medical UniversityGuangzhouChina

Objectives:The study aimed to evaluate quality of nephrolithometric nomograms to predict stone-free rates(SFRs)and complication rates(CRs)in case of minimally invasive percutaneous nephrolithotomy(PNL).In the last decade,nomograms have been introduced to estimate the SFRs and CRs of PNL.However,no data are available regarding their reliability in case of utilization of miniaturized devices.Herein we present a prospective multicentric study to evaluate reliability of Guy’s stone score(GSS),the stone size,tract length,obstruction,number of involved calyces,and essence of stone(S.T.O.N.E.)nephrolithometry score and Clinical Research Office of the Endourological Society(CROES)score in patients treated with minimally invasive PNL.Methods:We evaluated SFRs and CRs of 222 adult patients treated with miniaturized PNL.Patients were considered stone-free if no residual fragments of any size at post-operative unenhanced computed tomography scan.Patients demographics,SFRs,and CRs were reported and analyzed.Performances of nomograms were evaluated with the area under the curve(AUC).Results:We included 222 patients,the AUCs of GSS,CROES score,and S.T.O.N.E.nephrolithometry score were 0.69(95%confidence interval[CI]0.61-0.78),0.64(95%CI 0.56-0.73),and 0.62(95%CI 0.52-0.71),respectively.Regarding SFRs,at multivariate binomial logistic regression,only the GSS had significance with an odds ratio of 0.53(95%CI 0.31e0.95,p=0.04).We did not find significant correlation with complications,with only a trend for GSS.Conclusion:This is the first study evaluating nomograms in miniaturized PNL.They still show good reliability;however,our data showed lower performances compared to standard PNL.We emphasize the need of further studies to confirm this trend.A dedicated nomogram for minimally invasive PNL may be necessary.

关键词： Urolithiasis Nomogram Percutaneous nephrolithotomy Renal stone clavien-dindo

Stone-scoring systems for predicting complications in percutaneous nephrolithotomy:A systematic review of the literature

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Asian Journal of Urology 2023年第3期10卷 226-238页

作者： Giorgio Mazzon Simon Choong Antonio Celia Department of Urology AULSS7 PedemontanaSan Bassiano HospitalBassano Del GrappaItaly Institute of Urology University College Hospitals of LondonLondonUK

Objective:Percutaneous nephrolithotomy is a treatment of choice for larger stones of the upper urinary tract.Currently,several nephrolithometric nomograms for prediction of post-operative surgical outcomes have been proposed,although uncertainties still exist regarding their roles in the estimation of complications.Methods:We conducted a systematic review on PubMed and Web of Sciences databases including English studies with at least 100 cases and published between January 2010 and December 2021.We identified original articles evaluating correlations between the Guy’s stone score,the stone size(S),tract length(T),obstruction(O),number of involved calices(N),and essence or stone density(E)(S.T.O.N.E.),Clinical Research Office of the Endourological Society(CROES),and Seoul National University Renal Stone Complexity(S-ReSC)scores and post-operative complications in adult patients.We also included newly designed nomograms for prediction of specific complications.Results:After an initial search of 549 abstracts,we finally included a total of 18 papers.Of them,11 investigated traditional nephrolithometric nomograms,while seven newly designed nomograms were used to predict specific complications.Overall,7316 patients have been involved.In total,14 out of 18 papers are derived from retrospective single-center studies.Guy’s stone score obtained correlation with complications in five,S.T.O.N.E.nephrolithometry score in four,while CROES score and S-ReSC score in three and two,respectively.None of the studies investigated minimally invasive percutaneous nephrolithotomy(PCNL)and all cases have been conducted in prone position.Considering newly designed nomograms,none of them is currently externally validated;five of them predict post-operative infections;the remaining two have been designed for thromboembolic events and urinary leakage.Conclusion:This review presents all nomograms currently available in the PCNL field and highlights a certain number of concerns.Published data have appeared contradictory;more recent tools for

关键词： Percutaneous nephrolithotomy Complications Nomogram Stone-scoring system clavien-dindo

Effect of obesity on post-operative outcomes following colorectal cancer surgery

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World Journal of Gastrointestinal Oncology 2022年第7期14卷 1324-1336页

作者： Derek Mao David E Flynn Stephanie Yerkovich Kayla Tran Usha Gurunathan Manju D Chandrasegaram Faculty of Medicine and Health The University of SydneySydney 2050New South WalesAustralia Department of General Surgery The Prince Charles HospitalBrisbane 4032QueenslandAustralia of Medicine The University of QueenslandBrisbane 4006QueenslandAustralia Department of Pathology The Prince Charles HospitalBrisbane 4032QueenslandAustralia Department of Anaesthesia The Prince Charles HospitalBrisbane 4032QueenslandAustralia

BACKGROUND Colorectal cancer(CRC)resection is currently being undertaken in an increasing number of obese patients.Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery.AIM To evaluate the post-operative outcomes of obese patients following CRC resection,as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery.METHODS Six-hundred and fifteen CRC patients who underwent surgery at the Prince Charles Hospital between January 2010 and December 2020 were categorized into two groups based on body mass index(BMI):Obese[BMI≥30,n=182(29.6%)]and non-obese[BMI<30,n=433(70.4%)].Demographics,comorbidities,surgical features,and post-operative outcomes were compared between both groups.Postoperative outcomes were also compared between both groups in the subgroup of patients undergoing laparoscopic surgery[n=472:BMI≥30,n=136(28.8%);BMI<30,n=336(71.2%)].RESULTS Obese patients had a higher burden of cardiac(73.1%vs 56.8%;P<0.001)and respiratory comorbidities(37.4%vs 26.8%;P=0.01).Obese patients were also more likely to undergo conversion to an open procedure(12.8%vs 5.1%;P=0.002),but did not experience more postoperative complications(51.6%vs 44.1%;P=0.06)or high-grade complications(19.2%vs 14.1%;P=0.11).In the laparoscopic subgroup,however,obesity was associated with a higher prevalence of post-operative complications(47.8%vs 39.3%;P=0.05)but not high-grade complications(17.6%vs 11.0%;P=0.07).CONCLUSION Surgical resection of CRC in obese individuals is safe.A higher prevalence of post-operative complications in obese patients appears to only be in the context of laparoscopic surgery.

关键词： Colorectal cancer Obesity Body mass index Post-operative outcomes clavien-dindo

Initial suction drainage decreases severe postoperative complications after pancreatic trauma:A cohort study

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1652-1662页

作者： Kai-Wei Li Kai Wang Yue-Peng Hu Chao Yang Yun-Xuan Deng Xin-Yu Wang Yu-Xiu Liu Wei-Qin Li Wei-Wei Ding The First School of Clinical Medicine Southern Medical UniversityGuangzhou 510515Guangdong ProvinceChina Department of Critical Care Medicine Jinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210002Jiangsu ProvinceChina Division of Trauma and Surgical Intensive Care Unit Research Institute of General SurgeryJinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210002Jiangsu ProvinceChina Division of Data and Statistics Department of Critical Care MedicineJinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210002Jiangsu ProvinceChina

BACKGROUND Few studies have addressed the question of which drain types are more beneficial for patients with pancreatic trauma(PT).AIM To investigate whether sustained low negative pressure irrigation(NPI)suction drainage is superior to closed passive gravity(PG)drainage in PT patients.METHODS PT patients who underwent pancreatic surgery were enrolled consecutively at a referral trauma center from January 2009 to October 2021.The primary outcome was defined as the occurrence of severe complications(clavien-dindo grade≥Ⅲb).Multivariable logistic regression was used to model the primary outcome,and propensity score matching(PSM)was included in the regression-based sensitivity analysis.RESULTS In this study,146 patients underwent initial PG drainage,and 50 underwent initial NPI suction drainage.In the entire cohort,a multivariable logistic regression model showed that the adjusted risk for severe complications was decreased with NPI suction drainage[14/50(28.0%)vs 66/146(45.2%);odds ratio(OR),0.437;95%confidence interval(CI):0.203-0.940].After 1:1 PSM,44 matched pairs were identified.The proportion of each operative procedure performed for pancreatic injury-related and other intra-abdominal organ injury-related cases was comparable in the matched cohort.NPI suction drainage still showed a lower risk for severe complications[11/44(25.0%)vs 21/44(47.7%);OR,0.365;95%CI:0.148-0.901].A forest plot revealed that NPI suction drainage was associated with a lower risk of clavien-dindo severity in most subgroups.CONCLUSION This study,based on one of the largest PT populations in a single high-volume center,revealed that initial NPI suction drainage could be recommended as a safe and effective alternative for managing complex PT patients.

关键词： Pancreatic trauma Drainage Postoperative complications clavien-dindo Propensity score matching

New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients

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World Journal of Diabetes 2019年第2期10卷 78-86页

作者： Ohad Guetta Alex Vakhrushev Oleg Dukhno Amnon Ovnat Gilbert Sebbag Department General Surgery B Soroka University Medical Center

BACKGROUND It has been established that bariatric surgery,including laparoscopic sleeve gastrectomy(LSG),has a positive impact on type 2 diabetes mellitus(T2DM).However,less frequently T2DM is reported as a risk factor for complications with this type of surgery.AIM To evaluate the safety of LSG in T2DM.METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015.Data was collected through digitized records.Any deviation from normal postoperative care within the first 60 d was defined as an early complication,and further categorized into mild or severe.RESULTS Nine hundred eighty-four patients underwent LSG,among these 143(14.5%)were diagnosed with T2DM.There were 19 complications in the T2DM group(13.3%)compared to 59 cases in the non-T2DM(7.0%).Out of 19 complications in the T2DM group,12 were mild(8.4%)and 7 were severe(4.9%).Compared to the non-T2DM group,patients had a higher risk for mild complications(Odds-ratio 2.316,CI:1.163-4.611,P=0.017),but not for severe ones(P=0.615).An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications(P=0.013,CI:1.074-1.843)but not for mild ones.CONCLUSION Our data suggest that LSG is relatively safe for patients with T2DM.Whether preoperative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.

关键词： Bariatric surgery Laparoscopic sleeve gastrectomy Type 2 diabetes Complications Morbidity Hemoglobin A1c Fasting plasma glucose clavien-dindo classification

Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator

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World Journal of Gastroenterology 2019年第23期25卷 2833-2838页

作者： Roberto De la Plaza Llamas JoséM Ramia Department of General and Digestive Surgery Hospital Universitario de GuadalajaraGuadalajara 19002Spain

Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The clavien-dindo Classification is the most widely used system worldwide for assessing postoperative complications.However, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently,two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0(no complications) to 100(patient’s death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.

关键词： Morbidity Postoperative complications Health policy Comprehensive Complication Index clavien-dindo Classification Complication Severity Score

Complications Following Surgery for Gastric Cancer: Analysis of Prospectively Collected Data

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Journal of Cancer Therapy 2014年第14期5卷 1454-1466页

作者： Lorenzo Bruno Lucia Barni Sabrina Pacciani Gaia Masini Lorenzo Tofani Federica Tofani Filippo Melli Antonio Taddei Manuela Andonova Miloeva Luca Boni Giancarlo Freschi Paolo Bechi Department of Surgery and Translational Medicine University of Florence Florence Italy Clinical Trials Coordinating Center Azienda Ospedaliero-Universitaria Careggi Florence Italy

Background and Aims: The complication rate after surgery for gastric cancer varies according to the particular definition of morbidity, so it’s necessary to report them using a standardized method, the clavien-dindo system. The purpose of this study was to prospectively analyze all post-gastrectomy complications in patients with gastric adenocarcinoma according to the severity grade using clavien-dindo system, in order to identify risk factors for postoperative complications and their prognostic significance on survival. Methods: This study is based on data from 90 consecutive patients who underwent gastrectomy for gastric neoplasia between January 2010 and February 2014 at the same unit. 15 patients were excluded (benign tumors, GISTs, missing data). Complications were categorized according to the clavien-dindo classification (uncomplicated patients vs patients classified ≥Grade I). The following risk factors were studied: age, BMI, sex, operation method, extent of resection, duration of surgery, transfusions, TNM staging, and lymph node ratio. Multivariate logistic regression was used to evaluate the association between risk factors and presence of complications. To assess the effect on overall survival, after selection of covariates using backward elimination, the Cox proportional hazard model was applied. Results: Among these patients, 49 (65.3%) developed complications, stratified as follows: Grade I, 6 (8%);Grade II, 24 (32%);Grade III, 6 (8%);Grade IV, 13 (17.3%). The laparoscopic technique (OR = 0.050;95% CI = 0.005 - 0.550, p = 0.0143) and no transfusions (OR = 0.219;95% CI = 0.058 - 0.827, p = 0.0251) were found to reduce the incidence of postoperative complications in the multivariate analysis. With regard to the survival analysis, lymph node ratio, malnutrition, extended resection and presence of complications were significant predictors of reduced survival in the multivariate analysis. Conclusions: Some variables can predict the risk of postoperative complications, the occurrence of which is a predic

关键词： Gastric Cancer Complications clavien-dindo Classification Survival Probability