目的 通过综合考虑直肠癌患者术前和术后因素,旨在确定直肠癌术后发生吻合口瘘(anastomotic leak-age,AL)发生的危险因素,并构建有效预测术后AL的列线图模型.方法 选取2018-01/2023-05月在作者医院行直肠癌手术的188例患者进行单中心回顾性研究.依据是否发生AL将患者分为AL组(n=21)和非AL组(n=167).应用Logistic回归分析法对直肠癌术后发生AL危险因素进行分析,建立直肠癌术后AL列线图预测模型.列线图模型预测性能通过受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)评估.结果 与非AL组患者比较,AL组有饮酒史、术前肠梗阻、pTNM分期Ⅲ/Ⅳ期的患者比例更高,接受预防性造口术比例更低,术后早期疼痛数字评分法(numeric rating scale,NRS)评分更高(P均＜0.05).Logistic回归分析结果显示,术前肠梗阻、术后早期NRS评分是直肠癌患者术后发生AL的独立危险因素,而保留左结肠动脉、预防性造口术是直肠癌患者术后发生AL的保护因素(P＜0.05).对列线图预测模型的评估显示,ROC曲线的AUC为0.910(95％CI:0.853～0.968,P＜0.001),当最佳预测截止值为0.303时,特异性为95.82％,灵敏度为66.71％.结论 保留左结肠动脉和预防性造口术、术前肠梗阻和术后早期中重度疼痛等因素对直肠癌患者术后AL具有良好的预测能力.
Predictive Analysis of Risk Factors for Postoperative Anastomotic Leakage After Rectal Cancer Surgery
Objective To determine the risk factors of postoperative anastomotic leakage(AL)by considering the preoperative and postoperative factors in patients with rectal cancer,and to construct a nomogram model for the effective prediction of AL after surgery.Methods A single-center retrospective study was performed on 188 patients who under-went rectal cancer surgery in author's hospital from January 2018 to May 2023.The patients were divided into AL group(n=21)and non-AL group(n=167)according to the occurrence of AL.The risk factors of AL after rectal cancer sur-gery were analyzed by Logistic regression analysis,and the predictive model of AL nomogram after rectal cancer surgery was established.the predictive performance of the nomogram model was evaluated by the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results Compared with the patients in non-AL group,the patients in AL group had a higher proportion of alcohol consumption history,preoperative intestinal obstruction,pTNM stage Ⅲ/Ⅳ,lower proportion of preventive stomy and higher early postoperative pain(numeric rating scale,NRS)(all P＜0.05).Logistic regression analysis showed that preoperative intestinal obstruction and early postoperative NRS were independent risk factors for postoperative AL in rectal cancer patients,while left colic artery preservation and preventive stomy were protective factors for postoperative AL in rectal cancer patients(P＜0.05).Evaluation of the nomogram predictive model showed that the AUC of the ROC curve was 0.910(95％CI:0.853-0.968,P＜0.001),when the best predictive cut-off value was 0.303,the specificity was 95.82％and the sensitivity was 66.71％.Conclusion Retaining left colic artery and preventive stomy surgery,preoperative intestinal obstruction and early moderate to severe postoperative pain have good predictive effects on postoperative AL in patients with rectal cancer.
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