基于两种评分系统对结直肠癌根治术后并发症预测价值的研究  

Application of Two Scoring Systems in Prediction of Postoperative Complications after Radical Resection of Colorectal Cancer

作　　者：杜凯微 姜霞[1,2] 王园园 耿燕杰[1] 高天 兰天昊 王桂琦 DU Kaiwei;JIANG Xia;WANG Yuanyuan;GENG Yanjie;GAO Tian;LAN Tianhao;WANG Guiqi(Department of Gastrointestinal Surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050031,China;Hebei Key Laboratory of Precise Diagnosis and Treatment of Colorectal Cancer,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院胃肠外科,河北省石家庄市050031 [2]河北省大肠癌精准诊断与治疗重点实验室,河北省石家庄市050031

出　　处：《中国全科医学》2022年第27期3390-3394,共5页Chinese General Practice

基　　金：河北省政府资助项目(361034)。

摘　　要：背景结直肠癌是常见肿瘤,手术仍是其主要治疗手段之一。目前对结直肠癌手术治疗的研究十分成熟,却很少有根据术前、术中状态预测其术后并发症的研究。目的探讨POSSUM评分系统和年龄校正查尔森合并症(aCCI)指数对结直肠癌根治术术后并发症的预测价值。方法回顾性分析2016年6月至2020年9月在河北医科大学第一医院实施结直肠癌根治术的118例患者的临床资料,根据术后是否出现并发症分为并发症组(n=42)、无并发症组(n=76)。采用Spearman秩相关分析探讨结直肠癌根治术术后并发症与临床指标的关系,采用受试者工作特征曲线(ROC曲线)评价两种评分系统对结直肠癌根治术术后并发症的预测价值。结果并发症组预计死亡率(R1)、预计并发症发生率(R2),aCCI水平、术中失血量高于无并发症组,预计十年生存率(Z)、术前血红蛋白(Hb)水平低于无并发症组(P<0.05)。两组TNM分期比较,差异有统计学意义(P<0.05)。预测30 d内R1为0.065(0.039,0.131),30 d内R2为0.349(0.220,0.585),Z值为0.775(0.214,0.901)。实际术后30 d内36.1%(42/118)发生术后并发症,1.7%(2/118)死于吻合口瘘。术后有无并发症与TNM分期、术中失血量呈正相关,与术前Hb呈负相关(P<0.05)。R1、R2、aCCI指数预测结直肠癌根治术术后并发症的ROC曲线下面积(AUC)分别为0.727、0.728、0.638,最佳截断值分别为0.114、0.516、3.500,灵敏度分别为57.1%、57.1%、52.4%,特异度分别为81.6%、80.3%、65.8%。结论POSSUM评分和aCCI指数均对结直肠癌根治术术后并发症有预测价值,可用于指导临床决策。Background Colorectal cancer is a common tumor,and surgery is still one of the main treatment methods.Nowadays the research on surgical treatment of colorectal cancer is very mature,but that of predicting the possibilities of postoperative complications from preoperative and intraoperative status is scarce.Objective To investigate the predictive value of POSSUM system and aCCI index in postoperative complications after radical resection of colorectal cancer.Methods Retrospective analysis was performed on the clinical data of 118 patients performed colorectal cancer operation in the First Hospital of Hebei Medical University from June 2016 to September 2020.They were divided into complication group(n=42)and non-complication group(n=76)according to the incidence of postoperative complications.Spearman rank correlation was used to explore the relationship between postoperative complications after radical resection of colorectal cancer and clinical indicators.ROC curve was used to evaluate the predictive value of POSSUM system and aCCI index.Results R1,R2,aCCI levels and blood loss in the complication group were higher than those in the non-complication group,while Z and preoperative Hb levels were lower than those in the non-complication group(P<0.05).TNM staging ratois were compared in the two groups,and the difference was statistically significant(P<0.05).R1,R2 and Z were predicted to be 0.065(0.039,0.131),0.349(0.220,0.585)and 0.775(0.214,0.901)within 30 days.36.1%(42/118)developed postoperative complications within 30 days after operation,and 1.7%(2/118)died of anastomotic leakage.Postoperative complications were positively correlated with TNM stage and blood loss,and negatively correlated with preoperative Hb(P<0.05).The area under ROC curve(AUC)of R1,R2 and aCCI indexes for predicting postoperative complications after radical resection of colorectal cancer were 0.727,0.728 and 0.638,the optimal cut-off values were 0.114,0.516 and 3.500,the sensitivities were 57.1%,57.1%and 52.4%respectively,the specificity was

关 键 词：结直肠肿瘤 POSSUM系统 aCCI指数 术后并发症 数据相关性 预测 

分 类 号：R735.34[医药卫生—肿瘤]