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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 182 -186. doi: 10.3877/cma.j.issn.1674-3946.2021.02.018

所属专题： 文献；

论著

预测腹腔镜中低位直肠癌术后并发症危险因素的列线图模型的建立
陶亮1, 邵丽华1, 宋鹏1, 刘志坚1, 王萌1,†()   
  1. 1. 210008　南京，南京大学医学院附属南京鼓楼医院胃肠外科
  • 收稿日期:2020-12-03 出版日期:2021-04-26
  • 通信作者: 王萌

Establishment of a nomogram model in predicting risk factors of postoperative complications after laparoscopic surgery for middle and lower rectal Cancer

liang Tao1, Lihua Shao1, Peng Song1, Zhijian Liu1, Meng Wang1,†()   

  1. 1. Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Jiangsu 210008, China
  • Received:2020-12-03 Published:2021-04-26
  • Corresponding author: Meng Wang
  • Supported by:
    National Science Foundation for Young Scholars of China(81500482); Natural Science Foundation for Young Scholars of Jiangsu Province(BK20150105); Jiangsu Provincial Post Doctoral Fundation(1501121B)
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陶亮, 邵丽华, 宋鹏, 刘志坚, 王萌. 预测腹腔镜中低位直肠癌术后并发症危险因素的列线图模型的建立[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(02): 182-186.

liang Tao, Lihua Shao, Peng Song, Zhijian Liu, Meng Wang. Establishment of a nomogram model in predicting risk factors of postoperative complications after laparoscopic surgery for middle and lower rectal Cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(02): 182-186.

目的

探究腹腔镜中低位直肠癌术后并发症发生的危险因素，以此建立列线图模型并进行内验证。

方法

回顾性分析2018年1月至2019年10月接受腹腔镜直肠癌切除术的172例中低位直肠癌患者的临床资料。根据Clavien-Dindo分级系统对术后并发症进行分级，采用SPSS(版本20.0)软件通过T检验、秩和检验及卡方检验对≥Ⅱ级术后并发症的危险因素进行统计学分析，经单因素和多因素Logistic回归分析筛选≥Ⅱ级术后并发症的潜在危险因素，采用R软件(版本4.0.2)建立列线图模型。评价模型的区分度，内部验证运用Bootstrap法评价模型的符合度，并绘制校准曲线。采用DCA曲线验证模型的临床获益度。

结果

共计54例(31.4%)患者发生≥Ⅱ级术后并发症，多因素Logistic回归分析显示"术后3 d CRP≥88.6 mg/L"(OR＝3.371, P＝0.001)，"高龄"(OR＝1.070, P＝0.000)和"有造口"(OR＝3.192, P＝0.006)是导致术后并发症的独立危险因素。以此建立的列线图模型具有良好的区分度和校准度。

结论

基于3个独立危险因素的列线图模型对腹腔镜直肠癌术后并发症有较好的预测性能，具备一定的临床推广和参考价值。

关键词: 直肠肿瘤, 腹腔镜检查, 手术后并发症, 危险因素, 列线图, 预测模型
Objective

To identify risk factors of postoperative complications after laparoscopic surgery for middle and lower rectal cancer and to establish a nomogram model in predicting postoperative complications.

Methods

Patients who received laparoscopic surgery for middle and lower rectal cancer from January 2018 to October 2019 were enrolled in the present study, clinical data were analyzed. The complications were defined according to the Clavien-Dindo classification, patients with ≥ Level II complications were analyzed for associations in terms of demographic and medical characteristics. By using SPSS 20.0 software, potential risk factors of complications were identified from the characteristics variables per the strength of associations from univariate and multiple logistic regressions, from which nomogram models were subsequently generated. This nomogram model was validated and calibrated by using bootstrap method. The model was also evaluated for clinical significance by using the net benefit curve.

Results

Among 172 middle and lower rectal cancer patients, 54 (31.40%) had postoperative complications within 30 days postoperation. From the adjusted associations with complications, CRP of ≥88.60 mg/L on POD 3 (OR=3.371, P=0.001), advanced age (OR=1.070, P=0.000) and colostomy or ileostomy (OR=3.192, P=0.006), were found independently in predicting postoperative complications. The nomogram comprising the afore mentioned factors displayed good discrimination and predictive consistency.

Conclusion

The nomogram model based on three independent risk factors has good prediction performance for postoperative complications of laparoscopic rectal cancer, which has certain clinical promotion and reference value.

Key words: Rectal neoplasms, Laparoscopy, Postoperative complications, Risk factors, Nomograms, Prediction model
表1 172例接受腹腔镜直肠癌根治术患者术后并发症(≥Ⅱ级)危险因素单因素分析[例(%)]
相关因素 无术后并发症(n＝118) 有术后并发症(n＝54) P值
年龄(岁)   60.2±9.5 66.0±10.4 <0.001
性别 女 51 (43.2) 18(33.3) 0.018
男 67(56.8) 36 (66.7)
BMI(kg/m2)   23.9 ±3.3 23.6±2.9 0.566
高血压 否 81 (68.6) 36 (66.7) 0.796
是 37(31.4) 18 (33.3) 0.398
糖尿病 否 109(92.4) 49(90.7) 0.716
是 9(7.6) 5(9.3)
手术时长(min)   240.0(200.0～280.0) 230.0(195.0～268.8) 0.507a
术前Hb(g/L)   130.0(120.0～141.0) 128.0(114.5～141.8) 0.604a
术前ALB(g/L)   40.9(38.9～42.2) 39.9(37.8～41.0) 0.010a
术前WBC(×109/L)   8.0(6.5～9.4) 8.9(6.8～11.3) 0.115a
术后3 d Hb   114.0(103.3～125.0) 113.5(98.5～125.8) 0.763a
术后3 d ALB   34.6±3.1 33.5±3.2 0.033
术后3 d CRP(mg/L)   72.6(50.5～96.9) 95.9(72.2～130.2) <0.001a
术中出血量(ml)   100.0(50.0～100.0) 100.0(100.0～200.0) 0.278a
造口 无 98 (83.1) 35 (64.8) 0.008
有 20(16.9) 19 (35.2)
TNM分期Tis or Ⅰ 41 (34.7) 19 (35.2) 0.152
Ⅱ 31(26.3) 21(38.9)
Ⅲ 46(39.0) 14(25.9)
术后住院(d)   10.0(9.0～11.0) 14.0(12.0～21.5) <0.001a
表2 172例接受腹腔镜直肠癌根治术患者术后并发症(≥II级)危险因素Logistic单因素及多因素分析
相关因素 单因素分析OR(95%CI) P值 多因素分析OR(95%CI) P值
年龄 1.062(1.025～1.099) 0.001 1.070(1.070～1.030) 0.000
性别 1.522(0.777～2.984) 0.221    
术前ALB 0.871( 0.770～0.985) 0.028    
术后3 d ALB 0.891(0.800～0.992) 0.035    
术后3 d CRP 1.015(1.006～1.023) 0.000    
术后3 d CRP≥88.6 mg/L 3.440(1.758～6.731) 0.000 3.371(1.647～6.897) 0.001
有造口 3.138(1.422～6.925) 0.005 3.192(1.406～7.245) 0.006
图1 预测腹腔镜中低位直肠癌根治术术后并发症(≥Ⅱ级)的列线图模型
图2 预测腹腔镜中低位直肠癌根治术术后并发症(≥Ⅱ级)的列线图模型和单项指标的ROC曲线
图3 Broostrap法抽样1000次内验证列线图模型：A：ROC曲线，B：校准曲线
图4 DCA曲线法展示列线图模型的临床获益度和单项指标的临床获益度比较
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