食管癌根治术后吻合口瘘发生风险预测模型的系统评价与Meta分析  

Risk prediction model of anastomotic fistula after radical resection of esophageal cancer:A systematic review and meta-analysis

作　　者：李滔 蒋运兰[2] 康静 宋爽 杜秋凤 易晓冬 LI Tao;JIANG Yunlan;KANG Jing;SONG Shuang;DU Qiufeng;YI Xiaodong(Department of Nursing,Chengdu University of Traditional Chinese Medicine,Chengdu,610072,P.R.China;Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu,610075,P.R.China)

机构地区：[1]成都中医药大学护理学院,成都610072 [2]成都中医药大学附属医院,成都610075

出　　处：《中国胸心血管外科临床杂志》2025年第3期385-392,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的系统评价食管癌根治术后吻合口瘘风险预测模型,为选择合适的模型提供客观依据。方法全面检索中国知网、万方、维普、CBM、PubMed、EMbase、Web of Science、The Cochrane Library等数据库中与食管癌根治术后吻合口瘘风险预测模型相关的研究,检索时限为建库至2023年4月30日。由2名研究者独立筛选文献并提取资料信息,使用PROBAST工具进行文献偏倚风险及适用性评估,采用RevMan5.3软件对模型的共同预测因子的预测价值进行Meta分析。结果共纳入18篇文献,包括中文文献11篇和英文文献7篇。预测模型的受试者工作特征曲线下面积(area under the curve,AUC)为0.68~0.954,其中10个模型的AUC>0.8,提示预测性能较好,但纳入研究的偏倚风险较高,主要表现在研究设计及数据分析领域。共同预测因子的Meta分析结果显示,年龄、高血压史、糖尿病史、C反应蛋白、术前化疗史、低蛋白血症、外周血管病、肺部感染、胃网膜血管分支钙化是食管癌根治术后吻合口瘘发生的有效预测因子(P<0.05)。结论食管癌根治术后吻合口瘘风险预测模型研究尚处于发展阶段,未来研究可参考本研究经Meta分析归纳的常见预测因子,结合临床实际选择恰当的方法开发和验证吻合口瘘预测模型,对存在高风险吻合口瘘患者尽早给予针对性的预防措施。Objective To systematically evaluate the risk prediction model of anastomotic fistula after radical resection of esophageal cancer,and to provide objective basis for selecting a suitable model.Methods A comprehensive search was conducted on Chinese and English databases including CNKI,Wanfang,VIP,CBM,PubMed,EMbase,Web of Science,The Cochrane Library for relevant studies on the risk prediction model of anastomotic fistula after radical resection of esophageal cancer from inception to April 30,2023.Two researchers independently screened literatures and extracted data information.PROBAST tool was used to assess the risk of bias and applicability of included literatures.Meta-analysis was performed on the predictive value of common predictors in the model with RevMan 5.3 software.Results A total of 18 studies were included,including 11 Chinese literatures and 7 English literatures.The area under the curve(AUC)of the prediction models ranged from 0.68 to 0.954,and the AUC of 10 models was>0.8,indicating that the prediction performance was good,but the risk of bias in the included studies was high,mainly in the field of research design and data analysis.The results of the meta-analysis on common predictors showed that age,history of hypertension,history of diabetes,C-reactive protein,history of preoperative chemotherapy,hypoproteinemia,peripheral vascular disease,pulmonary infection,and calcification of gastric omental vascular branches are effective predictors for the occurrence of anastomotic leakage after radical surgery for esophageal cancer(P<0.05).Conclusion The study on the risk prediction model of anastomotic fistula after radical resection of esophageal cancer is still in the development stage.Future studies can refer to the common predictors summarized by this study,and select appropriate methods to develop and verify the anastomotic fistula prediction model in combination with clinical practice,so as to provide targeted preventive measures for patients with high-risk anastomotic fistula as soon as possible.

关 键 词：食管癌 吻合口瘘 风险预测模型 系统评价/META分析 

分 类 号：R73[医药卫生—肿瘤]