摘要目的 探讨腹腔镜右半结肠切除术后并发症的Clavien-Dindo分级及其预后因素.方法 回顾性收集北京协和医院基本外科结直肠专业组2016年10月至2018年2月收治的176例接受右半结肠切除术的患者的临床资料.男性95例,女性81例,年龄(62.4±12.7)岁.采用Clavien-Dindo分级分析术后并发症发生情况,采用单因素和多因素分析筛选右半结肠切除后并发症发生的独立预后因素.结果 176例患者中,2例患者发生术中并发症(1.1％),39例患者发生术后并发症(22.2％),其中10例患者发生两种以上并发症,共发生53例次并发症.Clavien-Dindo分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级并发症的比例分别为41.5％(22/53)、49.1％(26/53)、7.5％(4/53)、1.9％ (1/53).单因素分析结果显示,术后并发症的发生与患者年龄、近1年吸烟史、术中联合器官切除、淋巴结清扫范围(CME)、吻合方式(腹腔内吻合)及术前血AST和血钙水平相关(P值均＜0.05).多因素分析结果显示,吻合方式(腹腔内吻合)(95％ CI:2.46～12.85,P=0.00)和术前血AST水平(95％ CI:-0.018～0.00,P=0.04)和血钙水平(95％ CI:0.08～0.95,P=0.02)是术后并发症发生的独立预后因素.结论 右半结肠切除术后并发症主要为Clavien-Dindo分级Ⅰ、Ⅱ级.行腹腔镜右半结肠切除术时需谨慎选择腹腔内吻合,可能会增加术后并发症.

abstractsObjective To analyze the Clavien-Dindo classification of complications after right hemicolectomy and to explore the prognosis factors for postoperative complications.Methods The retrospective case-control study was adopted.The clinical data of 176 patients who underwent right hemicolectomy at Department of General Surgery,Peking Union Medical College Hospital from October 2016 to February 2018 were collected.There were 95 male and 81 female patients with age of (62.4± 12.7)years.The Clavien-Dindo classification was used for postoperative complications.Univariate and multivariate analysis were used to analyze the independent prognosis factors of complications after right colon resection.Results Of the 176 patients,2 patients had intraoperative complications (1.1％) and 39 patients had postoperative complications (22.2％),of which 10 cases had more than two complications,with a total of 53 complications.The proportions of Clavien-Dindo grade Ⅰ,Ⅱ,Ⅲ and Ⅳ complications were 41.5％ (22/53),49.1％ (26/53),7.5％ (4/53),and 1.9％ (1/53).Postoperative complications were associated with age,smoking history of the last 1 year,combined organ resection,lymph node dissection,intracorporeal anastomosis,and preoperative blood AST and Ca levels (all P ＜ 0.05).The results of multivariate analysis showed that intracorporeal anastomosis (OR =5.62,95％ CI:2.46 to 12.85,P=0.00),preoperative blood AST (OR=-0.009,95％ CI:-0.018 to 0.000,P=0.04) and Ca (OR=0.51,95％ CI:0.08 to 0.95,P=0.02) levels were independent prognosis factors affecting complications after right hemicolectomy.Conclusions Complications of right hemicolectomy were mainly Clavien-Dindo grade Ⅰ and Ⅱ.Laparoscopic intracorporeal anastomosis should be carefully chosen,which may increase postoperative complications.