腹腔镜胃癌根治术后胃瘫综合征的危险因素分析及预测模型构建  

Risk factor and prediction model construction for postoperative gastroparesis syndrome after laparoscopic radical gastrectomy for gastric cancer

作　　者：刘蓓 孙倩 薛颖 魏明丽 浦洁 LIU Bei;SUN Qian;XUE Ying;WEI Mingli;PU Jie(Department of Gastrointestinal Surgery,the Second People's Hospital of Huai'an City of Jiangsu Province,Huai'an,Jiangsu,223001)

机构地区：[1]江苏省淮安市第二人民医院胃肠外科,江苏淮安223001

出　　处：《实用临床医药杂志》2024年第23期65-69,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省淮安市卫生健康科研立项项目(HAWJ201916)。

摘　　要：目的分析接受腹腔镜胃癌根治术(LRG)治疗的胃癌患者发生术后胃瘫综合征(PGS)的危险因素,构建PGS的列线图预测模型并验证其预测效能。方法回顾性分析439例胃癌患者的临床资料,根据术后2个月内是否发生PGS将患者分成PGS组和对照组。采用Logistic回归分析筛选LRG患者发生PGS的危险因素,并基于筛选结果构建列线图预测模型。通过受试者工作特征(ROC)曲线评估列线图的区分度,通过校准曲线评估列线图的一致性。结果439例患者中,52例发生PGS,PGS发生率为11.85%。PGS组年龄≥60岁、伴有糖尿病、有腹部手术史、合并幽门梗阻、手术时间≥4 h及术中吻合方式为B-Ⅱ式的患者占比均高于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,伴有糖尿病、有腹部手术史、合并幽门梗阻、手术时间≥4 h、术中吻合方式为B-Ⅱ式是LRG患者发生PGS的危险因素(P<0.05)。内部验证结果显示,ROC曲线的曲线下面积为0.839(95%CI:0.773~0.905),校准曲线拟合良好,Hosmer-Lemeshow拟合优度检验结果为χ^(2)=9.078,P=0.247。结论伴有糖尿病、有腹部手术史、合并幽门梗阻、手术时间≥4 h、术中吻合方式为B-Ⅱ式是LRG患者发生PGS的危险因素,基于这些因素构建的列线图能够有效预测LRG患者的PGS发生风险。Objective To analyze the risk factors for postoperative gastroparesis syndrome(PGS)in gastric cancer patients undergoing laparoscopic radical gastrectomy(LRG)and to construct and validate a nomogram prediction model for PGS.Methods The clinical data of 439 gastric cancer patients were retrospectively analyzed.Patients were divided into PGS group and control group based on whether PGS occurred within 2 months after surgery.Logistic regression analysis was used to screen for risk factors of PGS in LRG patients,and a nomogram prediction model was constructed based on the screening results.The discriminative ability of the nomogram was assessed by the receiver operating characteristic(ROC)curve,and its consistency was evaluated by the calibration curve.Results Among 439 patients,52 developed PGS,with an incidence rate of 11.85%.The proportions of patients aged≥60 years,complicating with diabetes,having a history of abdominal surgery,complicating with pyloric obstruction,having surgery duration≥4 hours,and intraoperative anastomosis type of B-Ⅱ were higher in the PGS group than those in the control group(P<0.05).The results of multivariate Logistic regression analysis showed that diabetes,a history of abdominal surgery,pyloric obstruction,surgery duration≥4 hours,and intraoperative anastomosis type of B-Ⅱ were risk factors for PGS in LRG patients(P<0.05).Internal validation results showed that the area under the ROC curve was 0.839(95%CI,0.773 to 0.905),the calibration curve fitted well,and the Hosmer-Lemeshow goodness-of-fit test result was good(χ^(2)=9.078,P=0.247).Conclusion Diabetes,a history of abdominal surgery,pyloric obstruction,surgery duration≥4 hours,and intraoperative anastomosis type of B-Ⅱ are risk factors for PGS in LRG patients.The nomogram constructed based on these factors can effectively predict the risk of PGS in LRG patients.

关 键 词：腹腔镜 胃癌根治术 术后胃瘫综合征 危险因素 列线图 

分 类 号：R735.2[医药卫生—肿瘤] R473.73[医药卫生—临床医学] R319