腹腔镜结直肠癌根治术后吻合口瘘危险因素及列线图预测模型构建
Risk factors of anastomotic leakage after laparoscopic radical resection of colorectal cancer and establishment of nomogram prediction model
余建美 1沈丽 2赵海霞 1钱鑫成 1李良鹏3
作者信息
- 1. 226361 江苏省南通市,南通大学附属肿瘤医院医院重症医学科
- 2. 南通大学附属肿瘤医院普外科
- 3. 南京市第一医院胸外科
- 折叠
摘要
目的 探讨腹腔镜结直肠癌根治术后吻合口瘘的危险因素,建立其列线图预测模型.方法 以接受腹腔镜结直肠癌根治术的300例患者为研究对象,根据吻合口瘘发生与否分为吻合口瘘组(n=35)和非吻合口瘘组(n=265).采用单因素和多因素分析筛选影响结直肠癌根治术后吻合口瘘的危险因素,并根据Lo-gistic 回归结果构建影响直肠癌根治术后吻合口瘘危险因素的列线图模型,应用受试者工作特征(ROC)曲线验证模型的预测效能.结果 单因素分析结果显示,吻合口瘘组男性、BMI＞24kg/m2、TNM分期Ⅲ～Ⅳ、肿瘤距肛门距离＜7cm的占比高于非吻合口瘘组(P＜0.05),吻合口瘘组术前癌胚抗原(CEA)水平及术后降钙素原(PCT)水平高于非吻合口瘘组(P＜0.05),吻合口瘘组术后7d引流量及术后血红蛋白水平低于非吻合口瘘组(P＜0.05).多因素Logistic回归分析结果显示,男性、肿瘤距肛门距离＜7cm、术后PCT水平高及术后血红蛋白水平低是术后吻合口瘘发生的独立风险因素(P＜0.05).ROC曲线下AUC为0.763(95％CI:0.710～0.810),敏感性为94.30％,特异性为43.80％.结论 男性、肿瘤距肛门距离＜7cm、术后PCT水平高及术后血红蛋白水平低是腹腔镜结直肠癌根治术后发生吻合口瘘的独立危险因素,依据上述因素构建的列线图模型具有较好的预测效能.
Abstract
Objective To investigate the risk factors of anastomotic leakage after laparoscopic radical resection of colorectal cancer and to construct its nomogram prediction model.Methods The clinical data of patients undergoing laparoscopic radical resection of colorectal cancer were retrospectively analyzed.Three hundred pa-tients were included and divided into anastomotic leakage group(n=35)and non-anastomotic leakage group(n=265)according to whether there was anastomotic leakage after operation.Univariate and multivariate a-nalysis were used to establish the risk factors of anastomotic leakage after radical resection of colorectal canc-er,and a nomogram model of risk factors of anastomotic leakage after radical resection of colorectal cancer was constructed according to results of Logistic regression.The predictive efficacy of the model was verified by receiver operating characteristic(ROC)curve.Results Among 300 patients,35 had postoperative anastomot-ic leakage,with an incidence of 11.67％(35/300).The results of univariate analysis showed that the propor-tion of males,BMI＞24kg/m2,TNM stage Ⅲ～Ⅳ,and tumor-to-anal distance＜7cm in anastomotic leakage group was higher than that in non-anastomotic leakage group(P＜0.05).The preoperative carcinoembryonic antigen(CEA)level and postoperative procalcitonin(PCT)level in anastomotic leakage group were higher than those in non-anastomotic floor group(P＜0.05).Compared to non-anastomotic leakage group,the postop-erative 7d drainage volume and postoperative hemoglobin level in anastomotic leakage group were lower(P＜0.05).Multivariate logistic regression analysis showed that male,distance from tumor-to-anus＜7cm,high postoperative PCT level and high postoperative hemoglobin level were independent risk factors for anastomot-ic leakage(P＜0.05).The AUC under ROC curve of the nomogram prediction model was 0.763(95％CI:0.710-0.810),sensitivity was 94.30％,and specificity was 43.80％.Conclusion The nomogram model based on gender,tumor-to-anal distance,postoperative PCT and hemoglobin levels can better predict the probability of anastomotic leakage in patients after laparoscopic radical resection of colorectal cancer.
关键词
结直肠癌/吻合口瘘/危险因素/预测模型Key words
Colorectal cancer/Anastomotic leakage/Risk factors/Prediction model引用本文复制引用
出版年
2024
NETL
NSTL
万方数据