摘要
目的 探讨结直肠癌根治术后患者发生延迟性术后肠麻痹(PPOI)的危险因素.方法 回顾性分析2016年1月至2022年12月期间青岛大学附属医院896例行根治性结直肠癌切除术患者的临床资料,根据术后是否发生PPOI将患者分为PPOI组(59例)和非PPOI组(837例).通过单因素及多因素Logistic回归分析发生PPOI的危险因素.采用受试者工作特征曲线评估潜在预后因素的预测效能.结果 896例患者中59例患者(6.5％)术后发生PPOI.单因素及多因素Logistic回归分析显示,糖尿病(OR=2.360,P=0.018)、术前血清白蛋白水平＜35 g/L(OR=2.196,P=0.036)、术后硬膜外镇痛(OR=2.399,P=0.007)、开放手术(OR=3.413,P=0.001)以及ICU住院时间≥48 h(OR=6.134,P＜0.001)是发生PPOI的独立危险因素.联合上述危险因素构建受试者工作特征曲线得到曲线下面积为0.806(95％CI:0.698～0.838),准确度、敏感度、特异性分别为73.9％、74.0％、72.9％.结论 糖尿病、术前血清白蛋白水平、术后硬膜外镇痛、开放手术以及ICU住院时间≥48h是结直肠癌根治术后患者发生PPOI的危险因素.
Abstract
Objective To investigate the prognostic factors for the risk of prolonged postoperative ileus(PPOI)after colorectal cancer resection.Methods The clinical data of 896 patients undergoing radical colorectal cancer resection at Affiliated Hospital of Qingdao University between Jan 2016 and Dec 2022 were retrospectively analyzed.Patients were divided into PPOI group(59 cases)and non-PPOI group(837 cases)according to whether PPOI happened after surgery.Potential prognostic factors for the risk of developing PPOI were analyzed by univariate and multivariate Logistic regression.The receiver operating characteristic curve analysis was performed to assess the predictive power of potential prognosis factors.Results Fifty-nine patients(6.5％)developed PPOI after radical colorectal cancer resection.Univariate and multifactorial logistic regression analyses showed that diabetes mellitus(OR=2.360,P=0.018),preoperative albumin level＜35 g/L(OR=2.196,P=0.036),postoperative epidural analgesia(OR=2.399,P=0.007),open surgery(OR=3.413,P=0.001),and ICU hospitalization ≥ 48 h(OR=6.134,P＜0.001)were independent prognostic factors for PPOI.Combining the above prognostic factors to construct the receiver operating characteristic curve yielded an area under the curve of 0.806(95％CI:0.698-0.838),with an accuracy,sensitivity and.specificity of 73.9％,74.0％,72.9％,respectively.Conclusion Diabetes mellitus,preoperative albumin level,postoperative epidural analgesia,open surgery,and ICU hospitalization ≥ 48 h were risk factors for PPOI after radical colorectal cancer resection.
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