结直肠癌患者术后发生胃肠功能障碍的危险因素分析及预测模型构建  

Analysis of risk factors for postoperative gastrointestinal dysfunction in colorectal cancer patients and construction of a predictive model

作　　者：孙倩 刘蓓 朱华媛 Sun Qian;Liu Bei;Zhu Huayuan(Department of Gastrointestinal Surgery,The Second People’s Hospital of Huai’an,Huai’an 223001,Jiangsu,China)

机构地区：[1]淮安市第二人民医院胃肠外科,江苏淮安223001

出　　处：《结直肠肛门外科》2025年第1期45-54,共10页Journal of Colorectal & Anal Surgery

摘　　要：目的分析结直肠癌患者术后发生胃肠功能障碍的危险因素,并基于危险因素构建列线图预测模型。方法回顾性收集2020年1月至2024年6月在淮安市第二人民医院行结直肠癌手术的414例患者的临床资料,所有患者以7∶3的比例随机分为建模组和验证组。同时,根据建模组术后是否发生胃肠功能障碍将患者分为发生组和未发生组。收集患者的基线资料和临床资料,逐步筛选结直肠癌患者术后发生胃肠功能障碍的危险因素。在筛选出的危险因素基础上构建可预测结直肠癌患者术后发生胃肠功能障碍的列线图模型,并采用ROC曲线分析模型在建模组和验证组中的预测价值,以及采用Hosmer-Lemeshow拟合优度检验列线图模型的拟合程度。结果建模组和验证组的临床资料比较差异无统计学意义(P>0.05)。单因素分析结果显示发生组中年龄≥60岁、有吸烟史、BMI>25 kg/m^(2)、Ⅲ~Ⅳ期结直肠癌、低位直肠癌、有腹腔积液、肠系膜下动脉高位结扎、术前营养评分>4分、术前白蛋白水平≤35 g/L、术后无液体治疗、术后无多模式镇痛患者比例高于未发生组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,BMI>25 kg/m^(2)、低位直肠癌、术前白蛋白水平≤35 g/L、术后无液体治疗、术后无多模式镇痛是结直肠癌患者术后发生胃肠功能障碍的危险因素(P<0.05)。列线图模型预测建模组患者术后发生胃肠功能障碍ROC曲线的AUC=0.825,95%CI=0.775~0.876;列线图模型预测验证组患者术后发生胃肠功能障碍ROC曲线的AUC=0.818,95%CI=0.735~0.901。结论BMI>25 kg/m^(2)、低位直肠癌、术前白蛋白水平≤35 g/L、术后无液体治疗、术后无多模式镇痛是结直肠癌患者术后发生胃肠功能障碍的危险因素,构建的列线图预测模型准确度、区分度和一致性良好。Objectives To analyze the risk factors for postoperative gastrointestinal dysfunction in patients with colorectal cancer and to construct a nomogram predictive model based on these factors.Methods A retrospective analysis was conducted on the clinical data of 414 patients who underwent colorectal cancer surgery at The Second People’s Hospital of Huai’an from January 2020 to June 2024.The patients were randomly divided into a modeling group and a validation group in a 7∶3 ratio.The modeling group was further divided into an occurrence group and a non-occurrence group based on the occurrence of postoperative gastrointestinal dysfunction.Baseline and clinical data were collected to screen for risk factors for postoperative gastrointestinal dysfunction in colorectal cancer patients.A nomogram model was constructed based on the identified risk factors to predict postoperative gastrointestinal dysfunction in colorectal cancer patients.The ROC curve was used to analyze the predictive value of the model in both the modeling and validation groups,and the Hosmer-Lemeshow goodness-of-fit test was used to assess the fit of the nomogram model.Results There were no statistically significant differences in clinical data between the modeling group and the validation group(P>0.05).Univariate analysis showed that the proportions of patients with age≥60 years,smoking history,BMI>25 kg/m^(2),stageⅢ-Ⅳcolorectal cancer,low rectal cancer,abdominal fluid accumulation,high ligation of the inferior mesenteric artery,preoperative nutritional score>4 points,preoperative albumin level≤35 g/L,no fluid therapy after surgery,and no multimodal analgesia after surgery were higher in the occurrence group than in the non-occurrence group(P<0.05).Multivariate Logistic regression analysis revealed that BMI>25 kg/m^(2),low rectal cancer,preoperative albumin level≤35 g/L,no fluid therapy after surgery,and no multimodal analgesia after surgery were risk factors for postoperative gastrointestinal dysfunction in colorectal cancer patients(

关 键 词：结直肠癌 术后胃肠功能障碍 危险因素 预测模型 

分 类 号：R735.3[医药卫生—肿瘤]