完全腹腔镜右半结肠切除术联合腹腔热灌注化疗后延迟性肠麻痹危险因素分析与风险预测模型构建

doi:10.11904/j.issn.1002-3070.2023.06.003

实用肿瘤学杂志 ›› 2023, Vol. 37 ›› Issue (6): 472-477.doi: 10.11904/j.issn.1002-3070.2023.06.003

完全腹腔镜右半结肠切除术联合腹腔热灌注化疗后延迟性肠麻痹危险因素分析与风险预测模型构建

刘帛岩, 晏阳, 陈玉辉, 胡时栋, 杨宇, 李松岩

解放军总医院第一医学中心普通外科医学部(北京 100853)

收稿日期:2022-11-23 修回日期:2023-10-24 出版日期:2023-12-28 发布日期:2024-03-18
通讯作者: 李松岩,E-mail:lisongyan301@163.com
作者简介:刘帛岩,男,(1993-),硕士,住院医师,从事胃肠道肿瘤治疗的研究。
基金资助:
国家卫生健康委2021年微创手术临床应用规范化研究(编号:WA2021RW17)

Risk factors analysis and risk prediction model construction for delayed intestinal paralysis after complete laparoscopic right hemicolectomy combined with intraperitoneal thermal perfusion chemotherapy

LIU Boyan, YAN Yang, CHEN Yuhui, HU Shidong, YANG Yu, LI Songyan

Department of General Surgery,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China

Received:2022-11-23 Revised:2023-10-24 Online:2023-12-28 Published:2024-03-18

摘要/Abstract

摘要： 目的探讨结肠癌患者行完全腹腔镜右半结肠切除术联合腹腔热灌注化疗后延迟性术后肠麻痹(Prolonged postoperative ileus,PPOI)的危险因素并建立风险预测模型。方法回顾性分析2018年1月—2022年1月在解放军总医院第一医学中心普通外科医学部行完全腹腔镜右半结肠切除术联合腹腔热灌注化疗的83例结肠癌患者的病例资料,统计PPOI的发生情况,分析其危险因素,并构建列线图风险预测模型及进行效能验证。结果 83例患者中有26例(31.3%)发生PPOI。多因素logistic回归分析结果显示,合并糖尿病(OR=14.820,95% CI:2.819~77.918)、既往腹部手术史(OR=6.514,95% CI:1.433~29.604)、术前血红蛋白＜9 g/L(OR=5.338,95% CI:1.197~23.809)、术中出血超过200 mL(OR=4.869,95% CI:1.213~19.544)以及未关闭系膜裂孔(OR=5.462,95% CI:1.408~21.186)为PPOI发生的独立危险因素。依据多因素分析结果构建ROC曲线及PPOI列线图风险预测模型,内部验证一致性指数(C-index)为0.85(95% CI:0.735~0.957)。结论合并糖尿病、既往腹部手术史、术前血红蛋白＜9 g/L、术中出血超过200 mL以及未关闭系膜裂孔是完全腹腔镜右半结肠切除术联合腹腔热灌注化疗后发生PPOI的危险因素。构建的完全腹腔镜右半结肠切除术后发生PPOI的列线图风险预测模型具有良好的评价效果和临床应用价值。

关键词: 右半结肠癌, 完全腹腔镜右半结肠切除术, 延迟性术后肠梗阻, 危险因素, 风险预测模型

Abstract: Objective The aim of this study was to investigate the risk factors for delayed postoperative ileus(PPOI)in colon cancer patients undergoing complete laparoscopic right hemicolectomy combined with intraperitoneal thermal perfusion chemotherapy(HIPEC),and establish a risk prediction model. Methods A retrospective analysis was performed on the case data of 68 colon cancer patients who underwent complete laparoscopic right hemicolectomy combined with HIPEC at the Department of General Surgery,the First Medical Center of PLA General Hospital from January 2018 to January 2021.The incidence of PPOI was statistically analyzed,and its risk factors were analyzed.A nomogram of risk prediction model was constructed and the effectiveness was verified. Results Among the 83 patients,26 cases(31.3%)developed PPOI.Multivariate logistic regression analysis showed that diabetes(OR=14.820,95% CI:2.819-77.918),previous abdominal surgery(OR=6.514,95% CI:1.433-29.604),preoperative Hb＜9 g/L(OR=5.338,95% CI:1.197-23.809),intraoperative hemorrhage more than 200 mL(OR=4.869,95% CI:1.213-19.544),and not close the mesangial hiatal(OR=5.462,95% CI:1.408-21.186)were the risk factors for PPOI.Based on the results of multivariate analysis,a risk prediction model for ROC curve and PPOI nomogram was constructed.The internal validation consistency index(C-index)was 0.85(95% CI:0.735-0.957). Conclusion The risk factors for PPOI after complete laparoscopic right hemicolectomy combined with HIPEC are diabetes,previous abdominal surgery,preoperative Hb＜9 g/L,intraoperative hemorrhage more than 200 mL,and failure to close the mesangial hiatal.The constructed nomogram of risk prediction model for PPOI after complete laparoscopic right hemicolectomy has a good evaluating effect and clinical application value.

Key words: Right colon cancer, Complete laparoscopic right hemicolectomy, Delayed postoperative intestinal obstruction, Risk factors, Risk prediction model

中图分类号:

R735.3+5

刘帛岩, 晏阳, 陈玉辉, 胡时栋, 杨宇, 李松岩. 完全腹腔镜右半结肠切除术联合腹腔热灌注化疗后延迟性肠麻痹危险因素分析与风险预测模型构建[J]. 实用肿瘤学杂志, 2023, 37(6): 472-477.

LIU Boyan, YAN Yang, CHEN Yuhui, HU Shidong, YANG Yu, LI Songyan. Risk factors analysis and risk prediction model construction for delayed intestinal paralysis after complete laparoscopic right hemicolectomy combined with intraperitoneal thermal perfusion chemotherapy[J]. Journal of Practical Oncology, 2023, 37(6): 472-477.

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完全腹腔镜右半结肠切除术联合腹腔热灌注化疗后延迟性肠麻痹危险因素分析与风险预测模型构建

Risk factors analysis and risk prediction model construction for delayed intestinal paralysis after complete laparoscopic right hemicolectomy combined with intraperitoneal thermal perfusion chemotherapy

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