老年低位直肠癌患者术后吻合口漏发生的影响因素及预测模型构建  

Risk Factors and Prediction Model Construction of Anastomotic Leakage After Surgery for Low Rectal Cancer in Older Patients

作　　者：赵光艳 高婧[1] Zhao Guangyan;Gao Jing(Department I of General Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150000)

机构地区：[1]哈尔滨医科大学附属第一医院普外科,哈尔滨150000

出　　处：《国际老年医学杂志》2023年第2期167-171,共5页International Journal of Geriatrics

基　　金：黑龙江省卫生计生委科研项目(2018444)。

摘　　要：目的探究低位直肠癌患者术后吻合口漏(AL)发生的危险因素,并进一步构建预测模型。方法选取2019年1月~2021年12月哈尔滨医科大学附属第一医院收治的398例低位直肠癌患者进行回顾性分析。依据住院期间是否发生AL,分为AL组(53例)和对照组(345例)。通过电子病历系统提取患者的临床资料,采用多因素logistic回归分析AL发生的危险因素,在logistic回归分析的基础上构建预测模型,并采用ROC曲线对预测模型的效能进行测评。结果单因素分析显示,AL组年龄>70岁、糖尿病、肿瘤直径>4 cm、双吻合器、TNMⅢ期、术前新辅助放化疗、术后C反应蛋白(CRP)>40 mg/L的比例高于对照组(P<0.05),术前白蛋白(Alb)>30 g/L的比例低于对照组(P<0.05)。多因素logistic回归分析结果显示,术后双吻合器、TNMⅢ期、术前新辅助放化疗、CRP>40 mg/L是AL的独立危险因素(P<0.05),术前Alb>30 g/L是其保护因素(P<0.05)。ROC曲线分析显示,以上述5个变量为基础构建的模型,预测AL的曲线下面积为0.894(95%CI:0.847~0.941,P<0.001),灵敏度为79.25%,特异度为80.00%,约登指数为59.25%。结论术前新辅助放化疗、术后CRP升高、双吻合器、TNM分期Ⅲ期是老年低位直肠癌患者术后发生AL的独立危险因素,术前Alb是其保护因素,以此为基础构建的模型可预测AL发生的风险。Objective To investigate the risk factors for the occurrence of postoperative anastomotic leak(AL)in patients with low rectal cancer and to construct a prediction model.Methods A retrospective analysis was conducted on 398 patients with low rectal cancer admitted to the First Hospital of Harbin Medical University from January 2019 to December 2021.According to the occurrence of AL during hospitalization,they were divided into an AL group(53 cases)and a control group(345 cases).The clinical data of patients were extracted through the electronic medical record system,and the risk factors for AL were analyzed by multivariate logistic regression.The prediction model was constructed according to the result of multivariate logistic regression analysis,and the efficiency of the model was evaluated by receiver operating characteristic(ROC)curve.Results Univariate analysis showed that the proportions of age>70 years,diabetes mellitus,tumor diameter>4 cm,double anastomosis,TNM stageⅢ,preoperative neoadjuvant radiochemotherapy,and postoperative C-reactive protein(CRP)>40 mg/L were higher in AL group than in the control group(P<0.05),and the proportion of preoperative albumin(Alb)>30 g/L was lower than in the control group(P<0.05).Multivariate logistic regression analysis showed that postoperative double anastomosis,TNM stageⅢ,preoperative neoadjuvant radiochemotherapy,and CRP>40 mg/L were independent risk factors for AL(P<0.05),preoperative Alb>30 g/L was the protective factor(P<0.05).ROC curve analysis showed that the model constructed based on the above five variables predicted AL with an area under the curve was 0.894(95%CI:0.847-0.941,P<0.001),with a sensitivity of 79.25%,specificity of 80.00%and Youden index of 59.25%.Conclusion Preoperative neoadjuvant radiochemotherapy,postoperative elevated CRP,double anastomosis,and TNM stageⅢwere independent risk factors for AL in older patients with low rectal cancer after surgery,and preoperative Alb was the protective factor.The model constructed on this basis could predi

关 键 词：低位直肠癌 吻合口漏 白蛋白 C反应蛋白 双吻合器 术前新辅助放化疗 

分 类 号：R735.37[医药卫生—肿瘤]