中低位直肠癌根治术后实现教科书式结局的影响因素分析及预测模型的建立  

Analysis of influencing factors and establishment of prediction model to achieve textbook outcome after radical resection of middle and low rectal cancer

作　　者：郭振[1] 王子晨 张康洋 张伟[1] 吴刚 孙培春 GUO Zhen;WANG Zichen;ZHANG Kangyang;ZHANG Wei;WU Gang;SUN Peichun(Department of Gastrointestinal Surgery,Henan University People′s Hospital/Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院/河南省人民医院胃肠外科,河南郑州450003

出　　处：《胃肠病学和肝病学杂志》2024年第8期999-1004,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：河南省医学科技攻关计划项目(SBGJ202102025)。

摘　　要：目的 探讨中低位直肠癌根治术后实现教科书式结局(textbook outcome, TO)的影响因素。方法 回顾性分析2022年1月至2024年2月我院胃肠外科收治的182例中低位直肠癌患者的临床病理资料;TO定义为同时满足以下条件:无再次干预;肿瘤切缘阴性;术后住院时间≤14 d;30 d内无计划外再住院;90 d内无死亡;清扫淋巴结数目≥12枚;术后无严重并发症(Clavien-Dindo分级≥2)。结果 共计182例中低位直肠癌患者被纳入分析,其中123例(67.58%)患者术后实现了TO。所有患者均达到了肿瘤切缘阴性和90 d内无死亡;179例(98.35%)患者无再次干预,162例(89.01%)患者术后住院时间≤14 d, 181例(99.45%)患者30 d内无计划外再住院,163例(89.56%)患者清扫淋巴结数目≥12枚,123例(67.58%)患者术后无严重并发症。单因素分析结果显示,TO组与非TO组在手术方式、癌结节、NLR、PLR、SII方面比较,差异有统计学意义(P<0.05)。多因素分析结果显示,手术方式为Miles、存在癌结节、术前高SII是术后实现TO的独立影响因素(P<0.05)。结论 手术方式为Miles、存在癌结节、术前高SII是中低位直肠癌根治术后实现TO的独立影响因素。Objective To investigate the influencing factors for achieving textbook outcome(TO)after radical resection of middle and low rectal cancer.Methods A retrospective analysis was conducted on the clinical and pathological data of 182 patients with middle and low rectal cancer admitted to the Department of Gastrointestinal Surgery in our hospital from Jan.2022 to Feb.2024.TO was defined as meeting all the following conditions simultaneously:no re-intervention,negative tumor margin,postoperative hospital stay≤14 days,no unplanned readmission within 30 days,no death within 90 days,≥12 lymph nodes harvested lymph;and no severe complications postoperatively(Clavien-Dindo classification≥2).Results A total of 182 patients with middle and low rectal cancer were included in the analysis,of which 123(67.58%)patients achieved TO after surgery.All patients achieved negative tumor margins and no death within 90 days;179(98.35%)patients had no re-intervention,162(89.01%)patients had a postoperative stay≤14 days,and 181(99.45%)patients had unplanned readmissions within 30 days.Unplanned rehospitalization,163 patients(89.56%)had≥12 lymph nodes dissected,and 123 patients(67.58%)had no severe postoperative complications.Univariate analysis results showed that there were statistically significant differences between the TO group and the non-TO group in surgical methods,cancer nodules,NLR,PLR,and SII(P<0.05).Multivariate analysis showed that Miles surgical method,presence of cancer nodules,and high preoperative SII were independent influencing factors for achieving TO after surgery(P<0.05).Conclusion Miles surgical method,presence of cancer nodules,and high preoperative SII are independent influencing factors for achieving TO after radical resection of middle and low rectal cancer.

关 键 词：中低位直肠癌 教科书式结局 影响因素 预测模型 

分 类 号：R735.3[医药卫生—肿瘤]