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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (03) : 312 -316. doi: 10.3877/cma.j.issn.2095-3232.2023.03.012

临床研究

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
朱任飞1, 冯秋琪2, 肖锋3, 陈志4, 杨帆5,†()   
  1. 1. 226006　南通大学附属南通第三医院肝胆外科；210029　南京医科大学第一附属医院肝胆中心
    2. 226006　南通大学附属南通第三医院肝胆外科
    3. 226006　南通大学附属南通第三医院病理科
    4. 226599　南京中医药大学附属如皋中医院普通外科
    5. 226001　上海大学附属南通医院重症医学科
  • 收稿日期:2023-02-08 出版日期:2023-06-10
  • 通信作者: 杨帆
  • 基金资助:
    南通市市级科技计划项目(JCZ20119，JCZ21063); 南通市226人才项目(通委人才[2018]3)

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

Renfei Zhu1, Qiuqi Feng2, Feng Xiao3, Zhi Chen4, Fan Yang5,†()   

  1. 1. Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, China; Hepatobiliary Disease Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    2. Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, China
    3. Department of Pathology, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, China
    4. Department of General Surgery, Rugao Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Rugao 226599, China
    5. ICU, Nantong Hospital Affiliated to Shanghai University, Nantong 226001, China
  • Received:2023-02-08 Published:2023-06-10
  • Corresponding author: Fan Yang
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朱任飞, 冯秋琪, 肖锋, 陈志, 杨帆. 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[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 312-316.

Renfei Zhu, Qiuqi Feng, Feng Xiao, Zhi Chen, Fan Yang. Application of Clavien-Dindo classification and comprehensive complication index in safety evaluation of hepatectomy for elderly patients with hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(03): 312-316.

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χ2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（χ2=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。

关键词: 癌，肝细胞, 肝切除术, 高龄, Clavien-Dindo分级, 并发症综合指数
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).

Methods

Clinical 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.

Results

In 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 (χ2=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).

Conclusions

It 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.

Key words: Carcinoma, hepatocellular, Hepatectomy, Elderly, Clavien-Dindo classification, Comprehensive complication index
表1 高龄组和对照组肝癌肝切除患者术前一般资料比较
组别 例数 性别（例） HBsAg阳性（例） 肝硬化（例） AFP[μg/L，M（QR）] sFLR（%，±s） 肿瘤直径[cm，M（QR）] Child-Pugh分级（例） CNLC分期（例）
男 女 A级 B级 Ⅰa期 Ⅰb期
高龄组 35 29 6 28 30 50（2 272） 74±10 3.8（2.4） 34 1 29 6
对照组 61 51 10 55 57 39（796） 73±8 3.0（2.0） 61 0 53 8
统计值   χ2=0.010 χ2=1.962 χ2=0.211 Z=0.887 t=0.805 Z=1.680 - χ2=0.290
P值   0.924 0.161 0.561 0.375 0.423 0.093 0.187 0.590
表2 高龄组和对照组肝癌肝切除患者术后并发症及Clavien-Dindo分级比较（例）
组别 例数 术后并发症 Clavien-Dindo分级
腹腔积液 腹腔出血 肝衰竭 胆漏 胸腔积液 肺部感染 切口感染 Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级 Ⅴ级
高龄组 35 11 1 2 1 3 1 1 9 9 0 1 0
对照组 61 23 1 3 1 4 1 1 14 16 0 1 0
统计值   χ2=0.158 - - - - - - Z=-0.279
P值   0.691 1.000 1.000 1.000 1.000 1.000 1.000 0.780
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