开腹与腹腔镜结直肠癌根治术后并发症的分级与评估

目的:探讨开腹手术与腹腔镜结直肠癌根治术后并发症的分级及评估。方法:2009年6月至2011年8月前瞻性地连续纳入158例腹腔镜结直肠癌根治术患者(腹腔镜组)及158例开腹结直肠癌根治术患者(开腹组),对比两组患者术后4周内并发症发生情况。分三步评价并发症的严重性。首先,将术后所有并发症根据Clavien分级进行分类。第二步,5位研究员分别独自应用直观叙述问卷模式对并发症的严重程度进行分级,0表示无术后并发症,100表示术后死亡。第三步,分别用中位数、最低及最高值对两组患者术后并发症进行评价。结果:开腹组术后并发症发生率显著高于腹腔镜组(23.4%vs.13.9%,P<0.05),术后并发症严重程度高于腹腔镜组。在敏感性比较中,中位数、最高值及最低值取得了类似结果。结论:开腹结直肠癌根治术术后并发症发生率显著高于腹腔镜手术,术后并发症严重程度亦高于腹腔镜手术。应用此分级评估法可对开腹与腹腔镜结直肠癌根治术术后并发症的发生做出直接评价。

Classification and valuation of postoperative complications after laparoscopic and open radical resection for colorectal cancer

Objective:To explore classification and valuation of postoperative complications after laparoscopic and open radical resection for colorectal cancer.Methods:From Jun.2009 to Aug.2011,316 patients with colorectal cancer were divided into two groups(laparoscopic versus open,both n=158) prospectively and consecutively.The primary outcome was complications at four weeks,and they were compared between the two groups.A three-step methodology was used to assign severity weights to complications.Firstly,each complication was graded using the Clavien classification.Secondly,five reviewers were asked to independently and directly evaluate their perception of the severity of each class using a non-categorized visual analog scale.Zero represented an uneventful postoperative course,but 100 represented postoperative death.Thirdly,the median,lowest,and highest values assigned to each class of complications were used to compare weighted complication scores for laparoscopic and open groups.Results:Open group was associated with more complications than laparoscopic group(23.4% vs.13.9%,P=0.032),and complications of open group were more severe than those of laparoscopic group.In the sensitivity analysis,similar results were shown using the median,highest and lowest weights.Conclusions:Laparoscopic radical resection has fewer complications than open surgery for colorectal cancer,and complications of open surgery are more severe than those of laparoscopy.The methodology for the valuation of complications allows a direct outcome comparison of procedures with different postoperative complication profiles.