直肠癌患者术后近期并发症危险因素分析及列线图预测模型的构建  

Analysis of risk factors of postoperative short-term complications in rectal cancer patients and establishment of nomogram prediction model

作　　者：骆霞岗[1] 陆晨 马翔[1] 鲁明[1] 沈健[1] 董小刚[1] 周菲[1] 赵庆洪[1] 张建平[1] 喻春钊[1] Luo Xiagang;Lu Chen;Ma Xiang;Lu Ming;Shen Jian;Dong Xiaogang;Zhou Fei;Zhao Qinghong;Zhang Jianping;Yu Chunzhao(Department of General Surgery,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院普外科,210011

出　　处：《中华结直肠疾病电子杂志》2022年第2期127-134,共8页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家重点研发计划(政府间国际科技创新合作重点专项)(2018YFE0127300);江苏省社会发展重点项目(BE2019759);江苏省第五期“333工程”科研项目(BRA2020091);江苏省卫生和计划生育委员会指导性课题(Z201603);南京市卫生和计划生育委员会科技发展资金项目(YKK16233);南京市“十三五”卫生青年人才项目(QRX17107);南京医科大学科技发展基金面上项目(2017NJMU041)。

摘　　要：目的探讨直肠癌患者术后近期并发症发生的相关危险因素并构建临床预测列线图模型。方法采用回顾性研究方法,收集分析2015年1月至2018年9月在南京医科大学第二附属医院普外科行直肠癌根治术的患者临床病理资料及相关手术信息资料。共纳入204例患者,其中男性患者135例,女性患者69例;病理TNM分期0期11例,Ⅰ期42例,Ⅱ期62例,Ⅲ期89例。根据2009版改良Clavien-Dindo手术并发症分级标准对患者术后出现的并发症进行分级,将Ⅱ级以上的并发症定义为临床有意义并发症。分析患者一般基线特征、病理特征及手术相关信息特征与临床有意义并发症发生之间的关系,对临床变量采用单因素、多因素分析。运用R软件(R4.0.3)绘制列线图临床预测模型,采用ROC曲线及C-index验证和评价列线图模型。结果204例患者中,共有39例(19.11%)患者出现临床有意义并发症,术后常见的并发症依次为吻合口漏(14例,9.03%;行Dixon术式和结肠肛管吻合术共155例)、肠梗阻(14例,6.86%)、肺部感染(13例,6.37%)、肠造口相关并发症(5例,5.95%;包括Miles术式、Hartmann术式预防性造口共84例)、术后出血(9例,4.41%)、腹腔感染/盆腔感染(6例,2.94%)、排尿困难/尿潴留/尿路感染(5例,2.45%)、切口感染(3例,1.47%)、静脉血栓(1例,0.49%)。单因素分析显示:合并基础疾病(χ^(2)=6.677,P=0.010)、既往腹部手术史(χ^(2)=5.260,P=0.022)、术前白蛋白<40 g/L(χ^(2)=9.495,P=0.002)、术前CEA增高(χ^(2)=4.976,P=0.026)、肿瘤下缘距肛缘距离≤7 cm(χ^(2)=6.683,P=0.010)、术中出血量>100 mL(χ^(2)=10.694,P=0.001)是直肠癌术后出现临床有意义并发症的相关危险因素。多因素分析结果提示:合并基础疾病(OR=2.770,95%CI:1.175~6.531,P=0.020)、既往腹部手术史(OR=2.538,95%CI:1.023~6.295,P=0.044)、肿瘤下缘距肛缘距离≤7 cm(OR=2.376,95%CI:1.077~5.239,P=0.032)、术中出血量>100 mL(OR=3.154,95%CI:1.339~7.427,P=0.00Objective To investigate the risk factors of postoperative short-term complications in patients with rectal cancer and to establish a nomogram model to predict the postoperative short-term complications.Methods A retrospective study was conducted to collect and analyze the clinicopathological data and related surgical information of patients who underwent radical resection of rectal cancer in the Second Affiliated Hospital of Nanjing Medical University from January 2015 to September 2018.A total of 204 patients were collected,including 135 male patients and 69 female patients.Pathological TNM staging:11 cases of stage 0,42 cases of stageⅠ,62 cases of stageⅡand 89 cases of stageⅢ.The postoperative complications of gradeⅡand above according to the modified Clavien-Dindo classification of surgical complications(Version 2019)were defined as clinically significant complications.The relationship between the general baseline characteristics,pathological characteristics,operation information characteristics and the occurrence of clinically significant complications was analyzed and the clinical variables were analyzed by univariate analysis and multivariate analysis.The nomogram prediction model was established by R software(R4.0.3)and the nomogram model was verified and evaluated by ROC curve and C-index.Results Of the 204 patients,39(19.11%)had clinically significant complications.The common postoperative complications were anastomotic leakage(14 cases,9.03%;155 cases of Dixon and coloanal anastomosis),intestinal obstruction(14 cases,6.86%),pulmonary infection(13 cases,6.37%),stoma related complications(5 cases,5.95%;84 cases of Miles operation,Hartmann operation or preventive stoma),postoperative bleeding(9 cases,4.41%),abdominal infection/pelvic infection(6 cases,2.94%),dysuria/urinary retention/urinary tract infection(5 cases,2.45%),incision infection(3 cases,1.47%),venous thrombosis(1 case,0.49%).Univariate analysis showed that basic diseases(χ^(2)=6.677,P=0.010),previous abdominal surgery history(χ^(2)=5

关 键 词：直肠肿瘤 术后 近期并发症 危险因素 列线图 

分 类 号：R73[医药卫生—肿瘤]