E-PASS系统评估结直肠癌手术风险的临床价值  

Clinical Benefits of Predicting Surgical Risk by E-PASS in Colorectal Cancer Surgery

作　　者：胡宗莉[1,2] 黄睿[1,2] 孟玥[1,2] 陈琪[1,2] 汪晓东[2,3] 李立[2,3] 

机构地区：[1]四川大学华西临床医学院/华西医院,四川成都610041 [2]四川大学华西医院胃肠外科中心MCQ团队,四川成都610041 [3]四川大学华西医院胃肠外科中心,四川成都610041

出　　处：《中国普外基础与临床杂志》2011年第1期43-47,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生厅科学研究项目(项目编号:080271);四川大学大学生科研训练计划(项目编号:20101117)~~

摘　　要：目的采用生理能力与手术侵袭度评分系统(E-PASS)预测结直肠癌患者择期手术风险,探讨其在术后并发症风险预测中的临床应用价值。方法回顾性分析313例结直肠癌患者使用E-PASS评分系统评估其手术风险,比较E-PASS中的术前风险分数(PRS)、手术侵袭度分数(SSS)和综合风险分数(CRS)评分与实际手术预后的关系,并探讨E-PASS各项指标与术后风险的关系。结果纳入分析的患者中,有22例(7.0%)患者发生术后并发症。患者的年龄(P=0.003)、体重(P=0.019)、肿瘤组织学类型(P=0.033)、Dukes分期(P=0.001)、严重心脏疾病(P=0.019)、严重肺部疾病(P=0.000)、体能状态指数(P=0.000)、失血量/体重(P=0.007)、失血量(P=0.001)和手术时间(P=0.000)均与并发症的发生相关;肿瘤分化程度(P=0.503)、糖尿病(P=0.745)、ASA分级(P=0.085)和手术切口大小(P=0.726)与并发症的发生无关。有并发症组的PRS和CRS明显高于无并发症组(P<0.001),而SSS在2组间的差异无统计学意义(P=0.059)。结论 E-PASS评分系统是一个相对方便、有效和易操作的手术风险评估系统,能够较准确地预测结直肠癌患者术后短期并发症的发生。Objective To evaluate the usefulness of estimation of physiologic ability and surgical stress（E-PASS） for predicting postoperative complications in patients undergoing elective colorectal cancer surgery.Methods Patients underwent colorectal cancer surgery between August 2009 and October 2010 were analyzed retrospectively.E-PASS equations were applied to those patients for estimation of operative risk.The preoperative risk score（PRS）,surgical stress score（SSS）,and comprehensive risk score（CRS） of the E-PASS were compared with actual postoperative complications.The relationship between E-PASS variables and morbidity after colorectal cancer surgery was identified.Results Of the 313 patients,22（7.0%） had postoperative complications.Of all the E-PASS variables between complicative group and noncomplicative group,the morbidity was significantly correlated to age（P=0.003）,weight（P=0.019）,tumor histologic types（P=0.033）,Dukes stage（P=0.001）,severe heart disease（P=0.019）,severe pulmonary disease（P=0.000）,performance status（P=0.000）,loss of blood volume/body weight（P=0.007）,loss of blood volume（P=0.001） and operation time（P=0.001）.Differentiation degree of tumor（P=0.503）,diabetes（P=0.745）,ASA grade（P=0.085）,and size of surgical incision（P=0.726） were not significantly associated with postoperative complications.The PRS and CRS were higher in complicative group than those in noncomplicative group（P〈0.001）.But the difference of SSS between the two groups was not statistically significant（P=0.059）.Conclusion The E-PASS scoring system is a relatively simple,fast,and operable tool that can be used to predict short-term postoperative morbidity accurately for clinical decision-making in colorectal cancer surgery.

关 键 词：结直肠癌 生理能力与手术侵袭度 评估 并发症 

分 类 号：R735.3[医药卫生—肿瘤]