目的：采用 Clavien-Dindo并发症分级标准评估早期宫颈癌根治术后并发症及分析其危险因素。方法：回 顾性分析 2016 年 1 月—2020 年 12 月甘肃省人民医院和西安国际医学中心医院 145 例行达芬奇机器人辅助宫颈癌根 治术的早期宫颈癌患者的临床资料，采用 Clavien-Dindo 分级标准对患者术后并发症进行分级评估，单因素分析患者 基线资料，并将 P<0.05 的变量纳入多因素 Logistic 回归模型确定术后并发症的危险因素。结果：术后无并发症 84 例（57.9％），术后并发症按照 Clavien-Dindo 分级标准评估共 61 例（42.1％），Ⅰ级并发症占 42 例（29.0%）， Ⅱ级并发症 10 例（6.9%），Ⅲ级并发症 4 例（2.8%），Ⅳ级并发症 5 例（3.4%）。Logistic 单因素分析结果显 示，合并症、分期与术后并发症发生有关（P<0.05）。术中出血量、手术时间、新辅助化疗、是否进行腹主动脉 旁淋巴结切除、术后辅助化疗与机器人早期宫颈癌根治术后发生并发症无显著相关性（P>0.05）。从临床角度分 析，这 5 项因素有可能影响术后并发症的发生。多因素 Logistic 回归分析结果显示，ⅠB1 比ⅠB2~ ⅡB（OR=3.017， 95%CI=1.323~6.882，P=0.009）发生并发症的风险更低。有合并症（OR=0.212，95%CI=0.086~0.522，P=0.001）是 行达芬奇宫颈癌根治术后并发症的独立危险因素。结论：宫颈癌分期晚于ⅠB2 期（含ⅠB2 期），有合并症是术后并 发症发生的独立危险因素。因此我们建议宫颈癌局限于ⅠB1 期，在积极纠正术前合并症并加强围手术期管理的前提 下行达芬奇机器人宫颈癌根治术是安全、可行的。

Objective: To evaluate the postoperative complications in robot-assisted surgery for early cervical cancer and analyze related risk factors with Clavien-Dindo classification. Methods: The clinical data of 145 patients with early cervical cancer underwent robot-assisted radical hysterectomy in Gansu Provincial People’s Hospital and Xi’an International Medical Center Hospital from January 2016 to December 2020 were retrospectively analyzed. The postoperative complications were graded and evaluated by Clavien-Dindo classification method. The baseline data were analyzed with univariate analysis, and the variables of P<0.05 were included in the multivariate logistic regression model to determine the risk factors of postoperative complications. Results: According to Clavien-Dindo classification, 61 cases (42.1%) had postoperative complications. Among which, there were 42 cases of grade I (29.0%), 10 cases of grade Ⅱ (6.9%), 4 cases of grade Ⅲ (2.8%), and 5 cases of grade Ⅳ (3.4%). The results of logistic univariate analysis showed that complications and stages were related to the occurrence of postoperative complications (P<0.05). There was no significant correlation between complications after robotic radical hysterectomy for early cervical cancer with intraoperative bleeding, operative time, abdominal paraaortic lymph node resection, neoadjuvant chemotherapy, postoperative adjuvant chemotherapy (P>0.05). From a clinical point of view, these five factors may affect the occurrence of postoperative complications. The multivariate logistic regression results showed that ⅠB1 had a lower risk of complications than ⅠB2~ ⅡB(OR=3.017, 95%CI=1.323~6.882, P=0.009).Comorbidity (OR=0.212, 95%CI=0.086~0.522, P=0.001) was the independent risk factor for complications after robot-assisted radical hysterectomy. Conclusion: For patients with cervical cancer later than stage ⅠB2 (including stage ⅠB2), comorbidity is an independent risk factor for postoperative complications. Therefore, it is safe and feasible to perform Da Vinci robotic radical hysterectomy for stage ⅠB1 cervical cancer by actively correcting preoperative comorbidities and strengthening perioperative management.

收稿日期：2022-04-18  录用日期：2022-09-05 

Received Date: 2022-04-18  Accepted Date: 2022-09-05 

基金项目：陕西省重点研发计划项目（S2023-YF-YBSF-1181） 

Foundation Item: Key Research and Development Program of Shaanxi Province (S2023-YF-YBSF-1181) 

通讯作者：王海琳，Email：wanghailinyx@163.com 

Corresponding Author: WANG Hailin, Email: wanghailinx@163.com 

引用格式：王靖，高建建，刘平，等 . 早期宫颈癌机器人辅助手术后并发症 Clavien-Dindo 分级及危险因素分析 [J]. 机器人外科学 杂志（中英文），2023，4（5）：413-422. 

Citation: WANG J , GAO J J , LIU P, et al . Clavien-Dindo classification and risk factors of postoperative complications in robotassisted surgery for early cervical cancer [J]. Chinese Journal of Robotic Surgery, 2023, 4(5): 413-422.

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