腹腔镜辅助直肠癌手术中转开腹的危险因素分析及预测模型建立  

Analysis of Risk Factors for Convertion to Laparotomy in Laparoscopic Assisted Colorectal Surgery and Establishment of the Prediction Model

作　　者：钟武[1] 张磊昌[1] 钟世彪[1] 江志远[1] 陈利生[1] 

机构地区：[1]广西医科大学第一附属医院,广西壮族自治区南宁市530021

出　　处：《中国全科医学》2014年第30期3545-3549,共5页Chinese General Practice

基　　金：国家自然科学基金资助项目(30760246)

摘　　要：目的分析腹腔镜辅助直肠癌手术中转开腹的相关危险因素,建立概率预测模型,以指导临床诊疗。方法收集2005年12月—2013年12月广西医科大学第一附属医院由同一手术团队完成腹腔镜辅助直肠癌手术患者1 037例的临床资料,127例行中转开腹手术,中转开腹率为12.25%。采用单因素分析和多因素Logistic回归分析方法,探讨影响中转开腹的危险因素,并用判别分析方法建立概率预测模型。结果 1 037例腹腔镜手术中,127例中转开腹为开腹组,余910例为腹腔镜组;开腹组手术时间、术后住院时间、术后开始进食时间均长于腹腔镜组(P<0.05),开腹组术中失血量多于腹腔镜组(P<0.05),开腹组术后肠梗阻和切口感染率高于腹腔镜组(P<0.05),两组吻合口瘘和肺部感染发生率差异无统计学意义(P>0.05)。单因素分析结果显示:肿瘤位置、腹部手术史、肿瘤大小、BMI、TNM分期、是否存在梗阻、侵犯周围器官、远处转移与中转开腹相关(P<0.05);多因素Logistic回归模型结果显示,腹部手术史、肿瘤大小、BMI、TNM分期、梗阻、侵犯周围器官进入回归模型(P<0.05);建立腹腔镜辅助直肠癌手术中转开腹的概率预测模型:P=eY/(1+eY),Y=-3.873+3.231×X1+1.025×X2+1.866×X3+0.982×X4+3.137×X5+2.381×X6,灵敏度为74.02%,特异度为76.04%。结论腹部手术史、肿瘤大小、BMI、TNM分期、梗阻、侵犯周围器官是腹腔镜辅助直肠癌手术中转开腹的危险因素,术前正确评估腹腔镜辅助直肠癌手术中转开腹的危险因素,可减少中转开腹率。Objective To analyse the risk factors for conversion to laparotomy in laparoscopic assisted colorectal surgery,to establish the probabilistic prediction model,and to guide clinical practice. Methods The clinical data of 1 037 patients who underwent laparoscopic assisted colorectal surgery by the same surgical team in the First Affiliated Hospital of Guangxi Medical University from December 2005 to December 2013 were collected,127（ 12. 25%） patients underwent conversion to laparotomy,risk factors for conversion to laparotomy were evaluated by chi- square test and Logistic multiple regression analysis. Discriminant analysis was used to create the probabilistic prediction model. Results Of the 1 037 patients,127 cases who underwent conversion to laparotomy were selected as convert group,910 cases who underwent laparoscopic surgery were selected as laparoscopic resection group; the operation time,hospital stay and time for dieting in convert group were significantly longer than those in laparoscopic resection group（ P〈0. 05）,and the intraoperative blood loss in convert group was significantly more than that in laparoscopic resection group（ P〈0. 05）,but the intestinal obstruction rate and wound infection rate in convert group were significantly higher than those in the laparoscopic resection group,respectively（ P〈0. 05）,there was no significant difference in anastomotic leakage rate and pulmonary infection rate between two groups（ P〉0. 05）; univariate analysis results showed that tumor location,abdominal operation history,size of tumor,BMI,TNM stage,intestinal obstruction,invasion of adjacent organs and distant metastasis were correlated to the conversion to laparotomy（ P〈 0. 05）; the multivariate Logistic re-gression analysis results showed that abdominal operation history,size of tumor,BMI,TNM stage,intestinal obstruction and invasion of adjacent organs entered the model（ P〈0. 05）; then we established the probabilistic prediction model for conversion to laparotomy in laparosco

关 键 词：直肠肿瘤 腹腔镜检查 危险因素 预测 模型 统计学 

分 类 号：R735.37[医药卫生—肿瘤]