南方医科大学学报

南方医科大学学报 ›› 2015, Vol. 35 ›› Issue (09): 1344-.

• • 上一篇    下一篇

三种腔镜前列腺切除手术并发症比较及Clavien-Dindo分级应用

蔡芳震，陈朝虹，张建育   

  • 出版日期:2015-09-20 发布日期:2015-09-20

Application of Clavien-Dindo classification for comparing complications of three
endoscopic procedures for benign prostatic hyperplasia

  • Online:2015-09-20 Published:2015-09-20

HTML

PDF

1668

摘要： 目的比较经尿道前列腺电切术（TURP）、双极等离子切除术（PKRP）及钬激光剜除术（HoLEP）三种术式并发症差异，初步
探讨Clavien-Dindo分级对3种术式并发症标准化评价的应用价值。方法2010年1月至2013年12月在本院泌尿外科接受腔镜
手术的前列腺增生患者625例按照术式分为3组：TURP（214例）、PKRP（207例）和HoLEP（204例），分别统计3组各项并发症差
异并纳入Clavien-Dindo分级进行比较。结果3组患者一般资料比较差异无统计学意义（P>0.05），TURP组各项的并发症发生
率总体上高于PKRP组和HoLEP组，其中电解质失平衡、术中大量失血、尿路刺激症状、尿路堵塞、前列腺电切综合征、术后勃起
功能障碍3组间差异有统计学意义（P<0.05）。按照Clavien-Dindo分级，Ⅱ级并发症比较，TURP组显著高于PKRP组和HoLEP
组（P<0.05）；Ⅲ级和Ⅳ级并发症比较，TURP组显著高于HoLEP组（P<0.05）；Ⅰ级和Ⅴ级3组间差异无统计学意义（P>0.05）。结
论各项并发症和Clavien-Dindo分级结果比较表明PKRP和HoLEP并发症少，安全性高，值得临床推荐使用。Clavien-Dindo分
级有利于手术并发症评价和比较的标准化，但还需要进一步完善和发展。

Abstract: Objective To compare the incidences of complications associated with 3 different endoscopic procedures, namely
transurethral resection of prostate (TURP), bipolar plasmakinetic resection of the prostate (PKRP), and holmium laser
enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) and assess the clinical value of the
Clavien-Dindo classification system for standardizing the evaluation of the complications. Methods Between January 2010 and
December 2013, a total of 625 patients with BPH scheduled for endoscopic surgery underwent TURP (214 cases), PKRP (207
cases), or HoLEP (204 cases). The complications were recorded in each group and analyzed using the Clavien-Dindo
classification system. Results There was no significant difference in the baseline data among the 3 groups (P>0.05). TURP was
associated with a higher total incidence rate of complications than PKRP and HoLEP, and the incidences of electrolyte
disturbance, massive intraoperative hemorrhage, urinary irritation symptom, urinary blockage, transurethral resection
syndrome (TRUS), and erectile dysfunction (ED) differed significantly among the 3 groups (P<0.05). According to
Clavien-Dindo classification, the incidence of grade II complications was significantly higher in TURP group than in PKRP and
HoLEP groups (P<0.05), and that of grades III and IV complications was significantly higher in TURP group than in HoLEP
group (P<0.05); no significant difference was found in grade I or V complications among the 3 groups (P>0.05). Conclusion
According to the results of Clavien-Dindo classification analysis, PKRP and HoLEP are associated with fewer complications
with a better safety profile in the treatment of BPH. The current Clavien-Dindo classification system can contribute to
standardized evaluation of surgical complications but still needs further modifications for better performance.