直肠癌术后吻合口漏的术前危险因素分析及预测模型构建  

Analysis of risk factors of anastomotic leakage after rectal surgery and construction of a nomogram prediction model

作　　者：林振宇 钟彬 张建新 尚作宏 张涛 董庆泰 马丹丹 李中虎 金炜东 LIN Zhen-yu;ZHONG Bin;ZHANG Jian-xin(The First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China;不详)

机构地区：[1]南方医科大学第一临床医学院,广东广州510515 [2]中国人民解放军中部战区总医院普通外科,湖北武汉430070

出　　处：《中国实用外科杂志》2022年第7期810-814,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.81902501);湖北省卫生与计划生育委员会联合基金项目(No.WJ2018H0090)。

摘　　要：目的 探讨直肠癌术后发生吻合口漏的术前危险因素并构建预测模型。方法 回顾性分析2007-01-01至2016-12-31中国人民解放军中部战区总医院普通外科收治的行直肠癌根治术并作一期吻合的330例病人的临床资料,分析发生吻合口漏的术前危险因素。应用R软件完成列线图预测模型。通过受试者工作特征曲线(ROC)和校准曲线评估列线图预测模型的能力。另收集2017-01-01至2018-12-31收治的行直肠癌根治术并作一期吻合的57例病人资料作为外部验证数据。结果 330例中有42例术后发生吻合口漏(12.7%)。单因素分析结果显示,吻合口漏发生与术前营养支持、肿瘤距肛门距离、BMI、营养风险筛查评分(NRS2002)、美国麻醉师协会(ASA)评分、血红蛋白、前白蛋白相关(P均<0.05)。多因素Logistic回归分析结果显示,BMI≥25、NRS2002评分>3分、肿瘤距肛门距离≤10 cm、血红蛋白<120 g/L是术后发生吻合口漏的独立危险因素。根据多因素回归分析结果构建列线图预测模型,受试者工作特征曲线下面积(AUC)为0.874(95%CI 0.823-0.925)。内部验证显示,模型的一致性指数为0.869。外部验证采用时段验证,AUC为0.787(95%CI 0.632-0.942)。结论 BMI≥25、NRS2002评分>3分、肿瘤距肛门距离≤10 cm及血红蛋白<120 g/L是吻合口漏的独立危险因素,基于这些变量的列线图可作为临床决策参考。ObjectiveTo explore the preoperative risk factors of anastomotic leakage after rectal surgery,construct apreoperative prediction model and guide clinical decision-making.MethodsWe retrospectively analysed thepreoperative data of 330 patients who underwent radical resection of rectal carcinoma and primary anastomosis in theCentral Warring Area General Hospital of the Chinese People’s Liberation Army(formerly Wuhan General Hospital ofGuangzhou Military Region) between January 1,2007 and December 31,2016. To analyse the risk factors foranastomotic leakage. R software was used to complete the drawing of the nomogram prediction model. The receiveroperating characteristic curve(ROC) and calibration plots were used to assess predictive model performance. There were57 patients from January 1,2017 to December 31,2018 underwent radical resection of rectal carcinoma and primaryanastomosis for external validation.ResultsThere are 42 cases of anastomotic leakage that occurred in this study. Theincidence of anastomotic leakage was 12.73%(n=330). Univariate analysis showed nutritional support before the operation,distance from the tumor to the anus,body mass index(BMI),nutritional risk screening2002(NRS 2002 score),American Society ofAnesthesiologists(ASA) score,hemoglobin andprealbumin were significantly correlated withanastomotic leakage(P<0.05). Multivariateanalysis showed BMI≥ 25,NRS 2002 score>3,distance from the tumor to the anus≤ 10cm and hemoglobin<120g/L were independent risk factors for anastomotic leakage. According to the multivariate logisticregression analysis results,the nomogram prediction model was constructed. The area under the ROC curve is 0.874(95%CI:0.823~0.925). Through internal validation,the concordance index value of the model was 0.869. In the externalvalidation,statistical analysis showed that the AUC was 0.787(95% CI:0.632~0.942).ConclusionBMI≥ 25,NRS2002 score>3,distance from the tumor to the anus≤ 10cm,and hemoglobin<120g/L are independent risk factors foranastomotic leakage. The nomogra

关 键 词：直肠癌 吻合口漏 危险因素 预测模型 

分 类 号：R735.37[医药卫生—肿瘤]