食管切除术后延迟性肠麻痹的风险预测模型构建  

Construction of risk prediction model for prolonged postoperative ileus after esophagectomy

作　　者：梁蕊 于媛 薛一博 李东芳 李舒馨 夏思秋 孙捷 Liang Rui;Yu Yuan;Xue Yibo;Li Dongfang;Li Shuxin;Xia Siqiu;Sun Jie(Cancer Hospital,Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院胸外科,北京100021

出　　处：《中华实验外科杂志》2023年第8期1519-1521,共3页Chinese Journal of Experimental Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-C&T-B-069);中国癌症基金会"北京希望马拉松"专项基金(LC2020C02)。

摘　　要：目的探讨影响食管切除术后延迟性肠麻痹发生的危险因素, 建立风险预测模型, 为治疗提供依据。方法回顾分析2021年2月至2022年2月于中国医学科学院肿瘤医院全麻下行食管癌根治术的612例患者资料, 其中术后发生延迟性肠麻痹92例, 采用R语言做统计分析, 使用χ2检验和Logistic回归进行单因素和多因素分析, 生成列线图模型, 计算一致性指数, 采用自助抽样法进行内部验证并绘制校正曲线。结果单因素分析显示, 糖尿病(χ2=10.377, P<0.05)、手术方式(χ2=126.605, P<0.05)、贫血输血(χ2=8.393, P<0.05)和是否早期进食(χ2=21.025, P<0.05)与食管癌切除术后延迟性肠麻痹发生有关。多因素Logistic回归分析显示, 术前有糖尿病史[比值比(OR)=2.848, P<0.05]、开胸手术(OR=10.741, P<0.05)、贫血输血(OR=2.083, P<0.05)、非早期进食(OR=3.218, P<0.05)是食管切除术后延迟性肠麻痹发生的独立危险因素。依据多因素分析结果构建列线图风险预测模型, 内部验证一致性指数为0.815[95%可信区间(CI):0.766~0.863]。结论构建的食管癌术后发生延迟性肠麻痹的列线图风险预测模型具有良好评价效果和临床应用价值。Objective To investigate the risk factors of prolonged postoperative ileus after esophagectomy,establish a risk prediction model,and provide a basis for treatment.Methods A retrospective analysis was performed on the data of 612 patients who underwent esophagectomy in our hospital from February 2021 to February 2022,and 92 cases of prolonged postoperative ileus occurred after operation.R language was used for statistical analysis,chi-square test and Logistic regression were used for univariate and multivariate analysis,a nomogram model was generated,consistency index was calculated,bootstrap method was used for internal verification and calibration curve was drawn.Results Univariate analysis showed that diabetes(χ2=10.377,P<0.05),operation method(χ2=126.605,P<0.05),anemia with blood transfusion(χ2=8.393,P<0.05)and early feeding(χ2=21.025,P<0.05)were related to prolonged postoperative ileus after esophagectomy,P<0.05.Multivariate Logistic regression analysis showed that preoperative diabetes history[odds ratio(OR)=2.848,P<0.05],thoracotomy(OR=10.741,P<0.05),anemia with blood transfusion(OR=2.083,P<0.05)and non-early feeding(OR=3.218,P<0.05)were independent risk factors for prolonged postoperative ileus after esophagectomy,P<0.05.The nomogram risk prediction model was constructed based on the multivariate analysis results,and the internal validation consistency index was 0.815[95%confidence interval(CI):0.766-0.863].Conclusion The nomogram risk prediction model of prolonged postoperative ileus after esophagectomy has good evaluation effect and clinical application value.

关 键 词：食管切除术 延迟性肠麻痹 危险因素 风险预测模型 

分 类 号：R735.1[医药卫生—肿瘤]