根治性全胃切除术后吻合口漏列线图预测模型的建立与验证  

Construction and Validation of Nomogram Prediction Model for Anastomotic Leakage in Gastric Cancer Patients after Radical Total Gastrectomy

作　　者：刘颖[1] 龚细丹 王晓鹏 LIU Ying;GONG Xidan;WANG Xiaopeng(Affiliated Cancer Hospital of Fujian Medical University,Fuzhou 350014,China)

机构地区：[1]福建医科大学附属肿瘤医院(福建省肿瘤医院),福建福州350014

出　　处：《中外医学研究》2022年第26期179-184,共6页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：福建省肿瘤医院院内资助项目-人才引进项目(YJ-YJ-03)。

摘　　要：目的:分析根治性全胃切除术后吻合口漏的高危因素,建立列线图预测模型并验证其效能。方法:收集2012年2月-2021年9月于福建省肿瘤医院行根治性全胃切除术的892例患者,按照3∶1随机数字表法分为训练集(n=669)和验证集(n=223)。采用多因素Logistic回归分析吻合口漏的独立危险因素,通过R软件建立列线图预测模型,将训练集和验证集作为模型的内部验证和外部验证。结果:训练集,根治性全胃切除术后吻合口漏发生率为7.6%,单因素分析表明:年龄、糖尿病、肺功能不全、体重指数、术前存在营养风险、术前低白蛋白血症与吻合口漏均有关(P<0.05)。多因素分析表明年龄≥60岁、糖尿病、体重指数>24 kg/m^(2)、术前存在营养风险、肺功能不全均是吻合口漏的独立危险因素(P<0.05)。构建列线图预测模型并绘制受试者工作特征曲线(ROC),训练集和验证集曲线下面积(AUC)分别为0.760(95%CI:0.692,0.828)和0.741(95%CI:0.670,0.812);校准曲线结果显示两者的预测曲线与实际曲线一致性均良好。结论:本研究构建的根治性全胃切除术后吻合口漏列线图预测模型具有较好的区分度和校准度,有助于医护人员识别高危患者并及时采取有效的预防措施。Objective:To analyze the risk factors of anastomotic leakage after radical total gastrectomy,to establish a nomogram prediction model and verify its efficacy.Method:A total of 892 patients who underwent radical total gastrectomy in Fujian Cancer Hospital from February 2012 to September 2021 were collected.They were divided into training set (n=669) and validation set (n=223) according to the 3∶1 random number table method.Multivariate Logistic regression was used to analyze the independent risk factors of anastomotic leakage,and a nomogram prediction model was established by R software,and the training set and validation set were used as the internal and external verification of the model.Result:In training set,the incidence of anastomotic leakage after radical total gastrectomy was 7.6%.Univariate analysis showed that age,diabetes,pulmonary insufficiency,body mass index,preoperative nutritional risk and pulmonary insufficiency were all associated with anastomotic leakage (P<0.05).Multivariate analysis showed that age ≥60 years old,diabetes,body mass index >24 kg/m^(2),preoperative nutritional risk and pulmonary insufficiency were high risk factors for anastomotic leakage (P<0.05).We builded a nomogram prediction model and draw ROC.The AUC of the training set and the validation set were 0.760 (95%CI:0.692,0.828) and 0.741 (95%CI:0.670,0.812),respectively.The calibration curve results showed that the predicted and actual curves of both were in good agreement.Conclusion:The nomogram prediction model of anastomotic leakage after radical total gastrectomy constructed in this study has good discrimination and calibration,which is helpful for medical staff to identify high-risk patients and take effective preventive measures in time.

关 键 词：胃癌 根治性全胃切除术 吻合口漏 危险因素 列线图 

分 类 号：R735.2[医药卫生—肿瘤]