腹腔镜直肠癌手术后发生腹直肌萎缩的影响因素分析及预测模型构建

Influencing factors analysis of rectus abdominis atrophy after laparoscopic rectal cancer surgery and construction of prediction model

吕进 ¹吕成余 ¹徐牧 ²徐晓军 ¹王志 ¹王和明¹

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作者信息

1. 南京医科大学附属南京医院南京市第一医院普通外科,江苏南京,210006
2. 南京医科大学附属南京医院南京市第一医院检验科
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摘要

目的:探讨腹腔镜直肠癌手术后发生腹直肌萎缩的影响因素,并构建预测模型.方法:回顾性选择2020 年3 月至2023 年3 月收治的行腹腔镜根治手术的229 例直肠癌患者,收集临床相关资料,根据术后是否发生腹直肌萎缩将患者分为萎缩组(n=47)与对照组(n=182).Logistic回归分析直肠癌腹腔镜手术后发生腹直肌萎缩的因素,受试者工作特征曲线构建直肠癌腹腔镜术后发生腹直肌萎缩的预测模型,Hosmer-Lemeshow检验预测模型的校准度.结果:多因素Logistic回归分析显示,年龄较大、术后长期卧床、预防性造口、术后化疗、术后并发手术部位感染是直肠癌腹腔镜手术后发生腹直肌萎缩的危险因素(P<0.05),高白蛋白水平是保护因素(P<0.05).受试者工作特征曲线分析显示,预测模型预测直肠癌腹腔镜手术后发生腹直肌萎缩的曲线下面积为0.868(95%CI:0.817～0.909),灵敏度、特异度分别为85.11%与87.91%.Hosmer-Lemeshow检验显示预测模型具有较好的符合度(χ2=3.251,P>0.05).结论:年龄较大、术后长期卧床、预防性造口、术后化疗、手术部位感染、低白蛋白是直肠癌腹腔镜手术后腹直肌萎缩的相关因素,据此建立预测模型可较好地预测腹直肌萎缩风险.

Abstract

Objective:To investigate the influencing factors of rectus abdominis atrophy after laparoscopic rectal cancer surgery and establish a predictive model.Methods:From Mar.2020 to Mar.2023,229 patients with rectal cancer who underwent radical laparo-scopic surgery were retrospectively selected,and relevant clinical data were collected.According to whether the patients suffered from rectus abdominis atrophy after surgery,the patients were divided into atrophic group(n=47)and control group(n=182).The factors of rectus atrophy after laparoscopic rectal cancer surgery were analyzed by logistic regression.The predictive model of rectus abdominis atrophy after laparoscopic rectal cancer surgery was constructed by receiver operating characteristic curve.The calibration degree of the predictive model was tested by Hosmer-Lemeshow.Results:Multivariate logistic regression analysis showed that older age,postoperative long-term bed rest,prophylactic ostomy,postoperative chemotherapy and postoperative surgical site infection were risk factors for rectus abdominis atrophy after laparoscopic surgery for rectal cancer(P<0.05),and high albumin level was protective factor(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve of the predictive model for predicting rectus abdo-minis atrophy after laparoscopic rectal cancer surgery was 0.868(95%CI:0.817-0.909),and the sensitivity and specificity were 85.11%and87.91%,respectively.Hosmer-Lemeshow test showed that prediction model had a good coincidence(χ2=3.251,P>0.05).Conclusions:Older age,postoperative long-term bed rest,prophylactic ostomy,postoperative chemotherapy,surgical site infection and low albumin are the related factors of rectus abdominis atrophy after laparoscopic rectal cancer surgery,according above factors,a pre-diction model can be established to better predict the risk of rectus abdominis atrophy.

关键词

直肠肿瘤/腹腔镜检查/预防性造口/腹直肌萎缩/影响因素分析/预测模型

Key words

Rectal neoplasms/Laparoscopy/Prophylactic ostomy/Rectus abdominis atrophy/Root cause analysis/Prediction model

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基金项目

南京医科大学科技发展基金(NMUB20210199)

出版年

2024

腹腔镜外科杂志

山东大学

腹腔镜外科杂志

CSTPCD

影响因子：0.861

ISSN：1009-6612

参考文献量21

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