POSSUM评分系统对胃癌患者手术风险的评估  

Evaluation of POSSUM scoring system in radical gastrectomy for gastric cancer patients

作　　者：姚震旦[1] 杨宏[1] 崔明[1] 邢加迪[1] 张成海[1] 张楠[1] 陈蕾[1] 苏向前[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤微创外科恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华胃肠外科杂志》2015年第8期791-796,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81272766,81450028）;国家高技术研究发展计划（863）资助项目（2014AA020603）;首都临床特色应用研究（Z121107001012130）;北京市医院管理局临床医学发展专项经费资助（XM201309）;北京大学“985工程”三期临床医院合作专项;北京大学医学部医学交叉学科种子基金（2014-MB-04）

摘　　要：目的：应用POSSUM评分系统对胃癌患者手术风险进行评估并判断其评估的准确性，为胃癌患者手术方式的选择提供临床决策。方法回顾性分析2009年4月至2014年4月北京大学肿瘤医院胃肠肿瘤微创外科连续性施行的腹腔镜辅助及开腹胃癌根治术的310例患者的临床资料。腹腔镜组患者278例，开腹组患者32例。按照POSSUM评分系统计算两组患者术前生理学评分（PS）和手术创伤评分（OS），并预测并发症发生率（R1）；比较开腹组患者R1与实际并发症发生率的差异；腹腔镜组患者POSSUM评分采用传统和改良（对OS中手术范围的划分进行调整，分为R1传统和R1改良）两种评分系统，比较两种评分系统下腹腔镜组患者R1与实际并发症发生率的准确性；同时比较术前不同生理状态患者（低分组：PS≤20；高分组：PS≥21）腹腔镜与开腹手术后并发症发生率的高低。结果 POSSUM评分系统对开腹组患者术后并发症发生率的预测准确性尚可，其预测和实际并发症发生率的比值（E∶O）为1．2∶1．0。腹腔镜组患者R1改良为29．1％，实际发生率23．4％， E∶O 改良为1．2∶1．0，其准确性优于R1传统（38．5％， E∶O 传统为1．6∶1．0）。无论是改良POSSUM评分系统对于腹腔镜组患者、还是传统POSSUM评分系统对于开腹组患者，低危患者R1与实际并发症发生率相符，其E∶O分别为1．0∶1．0和0∶0；但在中、高危患者中，POSSUM评分系统均高估了患者术后的并发症发生率，腹腔镜组E∶O分别为1．6∶1．0和1．9∶1．0；开腹组E∶O分别为1．2∶10和1．3∶1．0。对于术前一般状况较差（PS≥21）的患者，选择腹腔镜手术，术后实际并发症发生率低于开腹组（27．3％比5／7， P＝0．020）。结论改良后的POSSUM评分系统较传统POSSUM评分系统能相对准确地预测腹腔镜辅助胃癌根治术后并发症发生率；对�Objective To assess the accuracy of POSSUM scoring system in predicting surgical risk in patients with gastric cancer, and provide a feasible reference to clinical decision. Methods Clinical data of 310 patients suffered from gastric cancer were analyzed retrospectively , including 278 cases in laparoscopic group and 32 cases in open group , between April 2009 and April 2014 in the department of minimally invasive gastrointestinal surgery, Peking University Cancer Hospital. Preoperative physiology score （PS）, operative score （OS） and predictive morbidity rate （R1） were calculated according to POSSUM scoring system , which were used to assess the accuracy of R1 in open group. Two different scoring systems （R1traditional and R1modified according to adjustment of operative excision area） were applied in the laparoscopic group, and were compared for predicting the accuracy of R1 in the laparoscopic group. Besides, postoperative morbidities were compared between the two groups of patients with different preoperative physiological status （low risk group： PS≤20, high risk group： PS≥21）. Results The predictive accuracy for open group patients were acceptable, and the ratio of expected and observed （E∶O） was 1.2∶1.0. In the laparoscopic group, the R1modified was 29.1%, and observed morbidity was 23.4% with an E∶O of 1.2∶1.0. The R1modified was more accurate than R1traditional （38.5%, E∶O traditional was 1.6∶1.0）. Both modified and traditional POSSUM scoring system predicted well in low risk patients in the laparoscopic and open group, and E∶O was 1.0∶1.0, as well as 0∶0. However, it overestimated morbidities in median and high risk patients for both laparoscopic and open group. E∶O was 1.6∶1.0, and 1.9∶1.0 in laparoscopic group, as well as 1.2∶1.0 and 1.3∶1.0 in open group. For patients in poor preoperative physiological status （PS≥21）, the morbidity in laparoscopic group was lower than that in open group （27.3% vs. 5/7, P=0.020）. Conclusions Modifi

关 键 词：胃肿瘤 POSSUM评分系统 胃切除术 腹腔镜 术后并发症 

分 类 号：R735.2[医药卫生—肿瘤]