直肠前切除术延迟性术后肠麻痹发生的危险因素分析与风险预测模型构建

杨宇; 李宇轩; 宋建霖; 刘智龙; 刘帛岩; 赵鹏跃; 朱圣宇; 杨星朋; 李松岩; 王玉锋; 杜晓辉

doi:10.3969/j.issn.2095-5227.2021.01.004

直肠前切除术延迟性术后肠麻痹发生的危险因素分析与风险预测模型构建

Risk factors of prolonged postoperative ileus after anterior resection of rectum and its prediction model establishment

摘要

摘要:
背景延迟性术后肠麻痹(prolonged postoperative ileus，PPOI)是结直肠手术后的常见并发症，关于直肠癌患者直肠前切除术(anterior resection of rectum，AR)后发生PPOI的危险因素相关研究很少。
目的探讨直肠癌患者AR后PPOI的危险因素并建立风险预测模型。
方法回顾分析解放军总医院第一医学中心普通外科医学部2016年8月- 2018年8月行AR直肠癌根治性治疗患者130例的病例资料，统计PPOI的发生情况，分析PPOI的危险因素，构建列线图风险预测模型并进行效能验证。
结果 130例行AR的患者中30例(23.1%)发生PPOI。单因素分析显示，合并高血压或糖尿病、术中出血大于200 mL及术后胃管留置时间大于48 h对术后发生PPOI的影响显著(P均＜0.05)。多因素分析结果显示，合并高血压(OR=3.012，95% CI：1.139 ~ 7.966)、术中出血大于200 mL(OR=5.318，95 CI：1.712 ~ 16.521)、术后胃管留置时间大于48 h(OR=5.379，95 CI：1.614 ~ 17.925)是PPOI发生的危险因素(P均＜0.05)。依据多因素分析结果构建PPOI列线图风险预测模型，内部验证一致性指数(C-index)为0.760(95% CI：0.670 ~ 0.849)。
结论合并高血压、术中出血大于200 mL、术后胃管留置时间大于48 h是AR患者发生PPOI的危险因素。构建的AR术后发生PPOI的列线图风险预测模型具有良好评价效果和临床应用价值。

Abstract:
Background Prolonged postoperative ileus (PPOI) is a common complication in colorectal surgeries. However, the risk factors for PPOI after anterior resection of rectum in patients with rectal cancer has not been well studied.
Objective To investigate the risk factors of prolonged postoperative ileus (PPOI) after anterior resection of rectum (AR) in patients with rectal cancer, and establish a risk prediction model.
Methods A retrospective analysis was performed in 130 patients who underwent radical anterior resection treatment of rectal cancer from August 2016 to August 2018, in the Department of General Surgery of Chinese PLA General Hospital. The occurrence of PPOI was counted, and the risk factors of PPOI were obtained by multivariate logistic regression analysis. The risk prediction model of nomogram was constructed and the effectiveness was verified.
Results Of the 130 patients included in the study, 30 (23.1%) cases were diagnosed with PPOI. Univariate analysis showed that patients with hypertension, diabetes, intraoperative hemorrhage greater than 200 mL and postoperative gastric tube indwelling time more than 48 hours had significant higher incidence of PPOI. Multivariate analysis results showed that hypertension (OR: 3.012, 95% CI: 1.139 - 7.966), intraoperative hemorrhage more than 200 mL (OR: 5.318, 95% CI: 1.712 -16.521) and postoperative gastric tube indwelling time more than 48 hours (OR: 5.379, 95% CI: 1.614 - 17.925) were the risk factors of PPOI. Based on the results of multivariate analysis, the PPOI occurrence risk prediction nomogram was constructed, and the internal verification consistency index (C-index) was 0.760 (95% CI: 0.670 - 0.849).
Conclusion Hypertension, intraoperative hemorrhage more than 200 mL and postoperative gastric tube indwelling time more than 48 hours are risk factors for PPOI in patients with rectal cancer after anterior rectal resection. The PPOI occurrence risk prediction nomogram has good performance in evaluation, and is worthy of generalizing.

HTML全文

参考文献(26)

施引文献

资源附件(0)