腹腔镜结直肠切除术中转开腹风险因素分析及评分系统初步建立  

Analysis of risk factor and establishment of scoring system for predicting laparoscopic colorectal surgery conversion to open surgery

作　　者：张广东[1] 张建立[1] 孙振青[1] 石新艳[1] 贺秀林[1] 王弥[1] 

机构地区：[1]青岛大学医学院附属医院东区普外科,山东青岛266003

出　　处：《中国内镜杂志》2008年第2期148-150,158,共4页China Journal of Endoscopy

摘　　要：目的分析腹腔镜结直肠切除术(LCS)中转开腹风险因素,根据风险因素建立预测LCS中转开腹的评分系统。方法对429例患者的临床资料进行回顾性研究。结果中转开腹68例,中转开腹率15.58%,应用Logistic回归分析确定LCS中转开腹风险因素为:年龄≥65岁(CI=2.115,P<0.05)、体指指数BMI≥25(CI=2.907,P<0.01)、手术例数≤25例(CI=1.900,P<0.05)、有腹部手术史(CI=3.205,P<0.05)、有转移(CI=30.115,P<0.01)、肿瘤≥6cm(CI=8.954,P<0.05),并计算出LCS中转开腹可能性方程,根据方程建立评分系统:年龄(≥65岁为7分,<65岁为0分)、体重(BMI≥25为11分,BMI<25为0分)、手术是否为前25例(是为5分,不是为0分)、是否有腹部手术史(是为12分,不是0分)、肿瘤大小(≥6cm为22分,<6cm为0分)、是否有转移(有为34分,无为0分)。计算病例得分后画出ROC曲线,预测转开腹得分为18.5分,敏感度0.765,特异度0.806。18.5分以下开腹率为5.21%,18.5分以上开腹率为42.62%(P<0.001)。结论该评分系统预测中转开腹简便易行,稳定可靠。[Objective] To analyze the risk factor of LCS conversion to open surgery, establish the scoring system that predicts LCS to open surgery. [Methods] Retrospective study was performed on 429 patients, who underwent LCS in our department. [Results] Conversion rate was 15.58%, the risk factor of LCS to open surgery included age≥65 （CI=2.115, P 〈0.05）, BMI≥25 （CI=2.907, P 〈0.01）, operation number≤25 （CI=1.900, P 〈0.05）, abdominal operation history （CI=3.205, P 〈0.05）, invasion or（and） metastasis （CI=30.115 P 〈0.01） and size of tumor≥6 cm （CI=8.954, P 〈0.05）. Calculated the function of probability that LCS converts to open surgery and established the scoring system with age （≥65 7, 〈65 0）, （BMI≥25 11, BMI〈25 0）, operation number ≤25 （yes 5, no 0）, abdominal operation history （yes 12, no 0）, size of tumor （≥6 cm 22, 〈6 cm 0）, invasion or metastasis （yes 34, no 0）. 18.5 predicted the conversion, with sensitivity of 0.765, specificity of 0.806. Conversion rate below 18.5 was 5.21%, above 18.5 was 42.62% （P 〈0.01）. [Conclusion] The scoring system that predicts laparoscopic colorectal surgery conversion to open surgery is simple, convenient and applicable.

关 键 词：腹腔镜结直肠手术 中转开腹 评分系统 

分 类 号：R195[医药卫生—卫生统计学]