胃癌根治术后胰瘘发生相关危险因素分析及风险预测评分模型的建立  

Related risk factors analysis of pancreatic fistula after radical resection of gastric cancer and establishment of risk prediction scoring model

作　　者：丁平安 张志栋[1] 杨沛刚[1] 田园[1] 占世鑫 郭洪海[1] 刘洋[1] 王冬[1] 李勇[1] 赵群[1] Ding Ping'an;Zhang Zhidong;Yang Peigang;Tian Yuan;Zhan Shixin;Guo Honghai;Liu Yang;Wang Dong;Li Yong;Zhao Qun(Department of Surgery 3,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院外三科,石家庄050011

出　　处：《肿瘤研究与临床》2021年第2期104-108,共5页Cancer Research and Clinic

基　　金：河北省卫生健康委员会县级公立医院适宜卫生技术推广入库项目(2019024);河北省政府资助临床医学优秀人才培养项目(2019012);河北省高等学校科学技术研究项目(ZD2019139)。

摘　　要：目的探讨影响胃癌根治术后胰瘘发生的危险因素,建立胰瘘发生风险预测评分模型。方法回顾性分析河北医科大学第四医院2019年1月至2020年1月收治的312例胃癌患者的临床病理资料。采用多因素logistic回归模型分析影响术后胰瘘发生的危险因素,根据危险因素建立风险预测评分模型;采用Hosmer-Lemeshow检验检测回归方程的拟合优度,采用受试者工作特征(ROC)曲线评价回归方程的区分度。结果 312例胃癌患者中行胃癌根治术后发生胰瘘27例(8.65%)。多因素logistic回归分析显示,男性(OR=5.312,95%CI 1.532~18.420,P=0.008)、年龄≥60岁(OR=4.928,95%CI 1.493~16.250,P=0.009)、术前合并糖尿病(OR=3.062,95%CI 1.091~8.589,P=0.034)、病灶位于胃体-胃窦(OR=3.121,95%CI 1.052~9.251,P=0.040)、术中网膜囊切除(OR=6.209,95%CI 2.084~18.478,P=0.001)、术中高于D2站淋巴结清扫(OR=3.114,95%CI 1.044~9.281,P=0.042)、术中联合脏器切除(OR=5.063,95%CI 1.473~17.400,P=0.010)、术前TNM分期为Ⅲ期(OR=4.973,95%CI 1.189~20.792,P=0.028)是胃癌根治术后胰瘘发生的独立危险因素。建立胃癌患者根治术后发生胰瘘的风险预测方程为P=-8.619+1.670X_(1)+1.595X_(2)+1.119X_(3)+1.138X_(4)+1.826X_(5)+1.136X_(6)+1.622X_(7)+1.604X_(8),各因素X为二项赋值(0或1),其中X_(1)~X_(8)分别为性别(男性为1)、年龄(≥60岁为1)、术前糖尿病史(有为1)、病灶部位(胃体-胃窦为1)、术中是否网膜囊切除(是为1)、术中是否高于D2站淋巴结清扫(是为1)、术中是否联合脏器切除(是为1)、术前TNM分期(Ⅲ期为1)。回归方程的拟合优度较高(P=0.395)。应用风险预测评分模型判断胰瘘发生的ROC曲线下面积为0.916(95%CI 0.872~0.960)(P<0.01);评分≥5分患者发生胰瘘的概率为40.90%,评分<5分患者发生胰瘘的概率为3.35%。结论胃癌根治术后胰瘘的发生与多种危险因素密切相关。通过建立胃癌根治术后胰瘘发生风险预测评分模型,围术期能够有Objective To investigate the risk factors of pancreatic fistula after radical resection of gastric cancer,and to establish a risk prediction scoring model for pancreatic fistula.Methods The clinico-pathological data of 312 patients with gastric cancer admitted to the Fourth Hospital of Hebei Medical University from January 2019 to January 2020 were retrospectively analyzed.Multiple factor logistic regression model was used to analyze the risk factors of pancreatic fistula after radical resection of gastric cancer,and a risk prediction scoring model based on the risk factors was established.Hosmer-Lemeshow test was used to detect the goodness of fit of regression equation,and receiver operating characteristics(ROC)curve was used to evaluate the distinction degree of regression equation.Results Among 312 patients with gastric cancer,27 cases(8.65%)had pancreatic fistula after radical resection of gastric cancer.Multiple factor logistic regression analysis showed that male patients(OR=5.312,95%CI 1.532-18.420,P=0.008),age≥60 years old(OR=4.928,95%CI 1.493-16.250,P=0.009),preoperative diabetes mellitus(OR=3.062,95%CI 1.091-8.589,P=0.034),lesion location in the gastric body-gastric antrum(OR=3.121,95%CI 1.052-9.251,P=0.040),intraoperative omental bursa resection(OR=6.209,95%CI 2.084-18.478,P=0.001),intraoperative lymph node dissection at D2+station(OR=3.114,95%CI 1.044-9.281,P=0.042),intraoperative combined organ resection(OR=5.063,95%CI 1.473-17.400,P=0.010),preoperative TNM stageⅢ(OR=4.973,95%CI 1.189-20.792,P=0.028)were independent risk factors for pancreatic fistula after radical resection of gastric cancer.A risk prediction equation of pancreatic fistula after radical resection of patients with gastric cancer was established:P=-8.619+1.670X_(1)+1.595X_(2)+1.119X_(3)+1.138X_(4)+1.826X_(5)+1.136X_(6)+1.622X_(7)+1.604X_(8);factor X was set as a binomial assignment(0 or 1);X_(1)-X_(8) were listed as follows respectively:gender(the male was 1),age(≥60 years old was 1),preoperative diabetes history(yes was 1),les

关 键 词：胃肿瘤 胰腺瘘 危险因素 胃切除术 Logistic模型 

分 类 号：R735.2[医药卫生—肿瘤]