胃癌患者腹腔镜术后发生消化道瘘的风险预测模型构建  

Construction of Risk Prediction Model for Gastrointestinal Fistula in Patients with Gastric Cancer after Laparoscopic Surgery

作　　者：曾应文 ZENG Yingwen(First People's Hospital of Fuzhou,Fuzhou 344000 Jiangxi,China)

机构地区：[1]抚州市第一人民医院,江西抚州344000

出　　处：《现代诊断与治疗》2023年第7期953-956,共4页Modern Diagnosis and Treatment

摘　　要：目的探讨胃癌患者腹腔镜术后消化道瘘(Gastrointestinal Fistula,GIF)发生的危险因素,并构建风险预测模型。方法回顾性分析2018年2月至2021年3月于我院腹腔镜术后发生消化道瘘的胃癌患者40例设为发生组,选取同期腹腔镜术后未发生消化道瘘的40例胃癌患者临床资料设为未发生组。对比两组临床资料的差异,采用多因素Logistic回归分析影响术后消化道瘘发生的危险因素,并采用Calibration曲线验证模型拟合度,绘制受试者工作特征曲线(ROC)进行预测效能评估。结果发生组年龄>60岁患者占比、合并糖尿病占比、术前贫血及术前白蛋白水平≤30 g/L患者占比均高于未发生组(P<0.05);多因素Logistic回归分析显示,年龄>60岁、术前白蛋白水平≤30 g/L为影响术后消化道瘘发生的危险因素;Calibration曲线显示校正曲线与理想曲线趋近重合(P>0.05);应用预测模型进行回顾性验证,ROC曲线下面积(AUC)为0.943(95%CI:0.916~0.968),灵敏度92.50%%、特异度87.50%、约登指数0.800;将年龄>60岁、术前白蛋白水平≤30 g/L单独作为预测因素绘制ROC曲线,结果显示构建的风险预测模型的预测效能最好(P<0.05)。结论高龄、低白蛋白水平均是影响胃癌患者腹腔镜术后发生GIF的危险因素,构建的预测模型对预测GIF的发生具有较好的效能。Objectives To investigate the risk factors of gastrointestinal fistula(GIF)after laparoscopic surgery in patients with gastric cancer,and to construct a risk prediction model.Methods The clinical data of gastric cancer patients who received laparoscopic treatment in our hospital from February 2018 to March 2021 were retrospectively analyzed.A total of 40 cases of postoperative gastrointestinal fistula were selected as the occurrence group,while the 40 gastric cancer patients who did not develop gastrointestinal fistula after laparoscopic surgery during the same period were selected as the non-occurrence group.The differences of clinical data between the two groups were compared.Multivariate logistic regression analysis was used to analyze the risk factors affecting the occurrence of postoperative gastrointestinal fistula.The Calibration curve was used to verify the model fitting degree,and the receiver operating characteristic curve(ROC)was drawn to evaluate the predictive efficiency.Results The proportion of patients aged>60 years old,the proportion of patients complicated with diabetes,the proportion of patients with preoperative anemia and preoperative albumin level≤30 g/L were significantly higher than those in the non-occurrence group(P<0.05).Multiple Logistic regression analysis showed that age>60 years old and preoperative albumin level≤30 g/L were the risk factors for postoperative gastrointestinal fistula(P<0.05).Calibration curve showed that the calibration curve was close to the ideal calibration curve(P>0.05).The area under ROC curve(AUC)was 0.943(95%CI:0.916~0.968),the sensitivity was 92.50%,the specificity was 87.50%,and the Youden index was 0.800.The established risk prediction model had the best predictive efficacy when age>60 years old and preoperative albumin level≤30 g/L were used as independent predictors to draw ROC curves(P<0.05).Conclusions Advanced age and low albumin level are risk factors for GIF in gastric cancer patients after laparoscopic surgery,and the prediction model establi

关 键 词：胃肿瘤 腹腔镜 消化道瘘 风险预测 模型构建 

分 类 号：R619[医药卫生—外科学]