食管癌术后胃肠减压数学模型的应用价值  

Application value of the mathematical model of gastrointestinal decompression after esophagectomy ofesophageal cancer

作　　者：赵彦[1] 郭杰[1] 游宾[1] 侯生才[1] 胡滨[1] 李辉[1] 

机构地区：[1]首都医科大学附属北京朝阳医院胸外科,100020

出　　处：《中华消化外科杂志》2017年第5期479-482,共4页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金面上项目（81470128）;首都医学发展科研基金（首发2014-1-4021）

摘　　要：目的验证食管癌术后胃肠减压数学模型的准确性，探讨该模型对食管癌术后并发症的预测价值。方法采用回顾性病例对照研究方法。收集2013年10月至2016年10月首都医科大学附属北京朝阳医院收治的192例行手术治疗食管癌患者的临床病理资料。192例患者中，术后无并发症患者160例．有并发症患者32例（术后吻合口瘘7例、肺部感染9例、胃肠功能紊乱16例）。根据患者具体情况选择合适的手术方式，术后记录每日胃肠减压量。根据术后胃肠减压量影响因素的回归方程：前5d平均每日引流量（mL）=262．287±132．873±管状胃-72．160x吸烟史-27．904±肿瘤病理学类型-36．368±年龄，计算术后胃肠减压量预测值，并与实际胃肠减压量进行比较。观察指标：（1）食管癌术后无并发症患者胃肠减压量预测值与实际值的比较。（2）食管癌术后有并发症患者胃肠减压量预测值与实际值的比较。符合正态分布的计量资料以x±s表示，两组比较采用配对样本t检验；偏态分布的计量资料以M（范围）表示，两组比较采用Wilcoxon符号秩检验。结果（1）食管癌术后无并发症患者胃肠减压量预测值与实际值的比较：160例食管癌术后无并发症患者胃肠减压量预测值为187mL（58±392mL），实际值为207mL（20-570mL），两者比较，差异无统计学意义（z=-1．106，P〉O．05）。（2）食管癌术后有并发症患者胃肠减压量预测值与实际值的比较：7例吻合口瘘患者中，颈部吻合口瘘1例，胸部吻合口瘘6例。7例吻合口瘘患者的胃肠减压量预测值为（215±58）mL，实际值为（338±106）mL，两者比较，差异有统计学意义（t=-3．139，P〈O．05）。9例术后肺部感染患者胃肠减压量预测值为（176±61）mL，实际值为（239±111）mL，两者比较．差异无统计学意义（t=-1．805，P〉O．05）。16例胃肠功能紊乱患者的胃肠Objective To verify the accuracy of the mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer and explore predictive value of the mathematical mode/ in the postoperative complications. Methods The retrospective case-control study was conducted. The elinicopatholo- gical data of 192 patients with esophageal cancer who underwent esophagectomy in the Beijing Chaoyang Hospital of Capital Medical University between October 2013 and October 2016 were collected. Among 192 patients, 160 didn＇t have postoperative complications and 32 had postoperative complications （7 with postoperative anastomotic leakage, 9 with pulmonary infection and 16 with dysfunction of gastralintestinal tract）. Patients selected the appropriate surgical procedures according to individual conditions, and then volume of gastrointestinal decompression was recorded daily. According to the regression equation of influencing factors of volume of postoperative gastrointestinal decompression： average daily drainage volume within 5 days （mL）= 262.287 ± 132.873 x tubular stomach-72.160 x smoking history-27.904 x pathological type of tumor-36.368 x age, predictive value of postoperative gastrointestinal decompression was calculated and compared with real volume of gastrointestinal decompression. Observation indicators ： （1） compm＇ison between predictive value and real volume of postoperative gastrointestinal decompression in patients without complications; （2） comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients with complications. Measurement data with normal distribution were represented as ：s±s and comparison was analyzed using the paired-samples t test. Measurement data with skewed distribution were described as M （ range）, and comparison was analyzed using the Wilcoxon signed rank tests. Results （ 1 ） Comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients without c

关 键 词：食管肿瘤 食管切除术 胃肠减压 术后并发症 多元线性回归 

分 类 号：R735.1[医药卫生—肿瘤]