结直肠癌术后并发症的风险预测模型_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

高铭 ¹ , 戴刚 ¹ , 蔡卓玮 ¹ , 蔡一亭 ¹ ,  费哲为 ^1,2

1. ;
2. ;

Corresponding author：

费哲为, Email: zheweifei2013@sina.cn

Keywords：

结直肠癌; 术后并发症; 风险预测模型

DOI：

10.7507/1007-9424.202004122

Video：

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目的探讨与结直肠癌术后并发症相关的主要危险因素并建立风险预测模型。方法回顾性收集 2015 年 1 月至 2016 年 12 月期间于新华医院崇明分院、堡镇医院及庙镇医院行结直肠癌手术且符合本研究纳入条件患者的临床病理资料，分析结直肠癌术后并发症发生的危险因素并建立风险预测模型，同时采用回代样本进行验证。结果本研究共纳入符合条件的结直肠癌手术患者 450 例，术后发生并发症 67 例，并发症发生率为 14.9%。单因素分析结果显示，患者的年龄高、合并糖尿病、合并心脑血管疾病、合并慢性阻塞性肺炎、无术前化疗、ASA 分级高、手术持续时间长、TNM 分期晚、肿瘤分化程度低、主刀手术例数少、术中输血及术前营养不良这 12 个因素与结直肠癌根治术后并发症发生有关（P<0.05）；进一步行多因素 logistic 回归分析结果显示，这 12 个因素是结直肠癌根治术后并发症发生的危险因素（P<0.05），通过将包括这 12 个危险因素与常数项建立的 logistic 回归风险模型判断结直肠癌术后并发症的灵敏度和特异度分别为 68.7%（46/67）和84.9%（325/383）；采用 40 例回代样本进行验证，此模型判断结直肠癌术后并发症的灵敏度和特异度分别为 66.7%（18/27）和 84.6%（11/13）。结论本研究根据多因素 logistic 回归分析得出了 12 项结直肠癌术后并发症发生独立的危险因素并以此建立的回归风险模型能够较为准确地预测结直肠癌术后的并发症发生率。

Citation： 高铭, 戴刚, 蔡卓玮, 蔡一亭, 费哲为. 结直肠癌术后并发症的风险预测模型. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(2): 252-255. doi: 10.7507/1007-9424.202004122 Copy

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2.	Chang YT, Huang MY, Yeh YS, et al. A prospective study of comparing multi-gene biomarker chip and serum carcinoembryonic antigen in the postoperative surveillance for patients with stage Ⅰ−Ⅲ colorectal cancer. PLoS One, 2016, 11(10): e0163264.
3.	中华医学会呼吸病学分会. 医院获得性肺炎诊断和治疗指南(草案). 中华结核和呼吸杂志, 1999, 22(4): 201-203.
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6.	Kim JY, Park IJ, Kim HR, et al. Post-pulmonary metastasectomy prognosis after curative resection for colorectal cancer. Oncotarget, 2017, 8(22): 36566-36577.
7.	Samuelsson KS, Egenvall M, Klarin I, et al. Inappropriate drug use in elderly patients is associated with prolonged hospital stay and increased postoperative mortality after colorectal cancer surgery: a population-based study. Colorectal Dis, 2016, 18(2): 155-162.
8.	许钊荣, 池畔. 腹腔镜与开腹结直肠癌根治术后并发症发生率的比较. 中华胃肠外科杂志, 2012, 15(8): 810-813.
9.	Couwenberg AM, Burbach MJ, Smits AB, et al. The impact of retractor SPONGE-assisted laparoscopic surgery on duration of hospital stay and postoperative complications in patients with colorectal cancer (SPONGE trial): study protocol for a randomized controlled trial. Trials, 2016, 17(1): 132.
10.	Matsuda M, Tsuruta M, Hasegawa H, et al. Transanal drainage tube placement to prevent anastomotic leakage following colorectal cancer surgery with double stapling reconstruction. Surg Today, 2016, 46(5): 613-620.
11.	Casal Núñez JE, Vigorita V, Ruano Poblador A, et al. Presacral venous bleeding during mobilization in rectal cancer. World J Gastroenterol, 2017, 23(9): 1712-1719.
12.	Sakari T, Sjödahl R, Påhlman L, et al. Role of icodextrin in the prevention of small bowel obstruction. Safety randomized patients control of the first 300 in the ADEPT trial. Colorectal Dis, 2016, 18(3): 295-300.
13.	McSorley ST, Horgan PG, McMillan DC. The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol, 2016, 97: 168-177.
14.	Yaegashi M, Otsuka K, Kimura T, et al. Transumbilical abdominal incision for laparoscopic colorectal surgery does not increase the risk of postoperative surgical site infection. Int J Colorectal Dis, 2017, 32(5): 715-722.
15.	Yamada T, Okabayashi K, Hasegawa H, et al. Age, preoperative subcutaneous fat area, and open laparotomy are risk factors for incisional hernia following colorectal cancer surgery. Ann Surg Oncol, 2016, 23(Suppl 2): S236-S241.
16.	Floodeen H, Hallböök O, Hagberg LA, et al. Costs and resource use following defunctioning stoma in low anterior resection for cancer-A long-term analysis of a randomized multicenter trial. Eur J Surg Oncol, 2017, 43(2): 330-336.
17.	McSorley ST, Khor BY, MacKay GJ, et al. Examination of a CRP first approach for the detection of postoperative complications in patients undergoing surgery for colorectal cancer: A pragmatic study. Medicine (Baltimore), 2017, 96(7): e6133.
18.	Anderin K, Gustafsson UO, Thorell A, et al. The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer. Eur J Surg Oncol, 2016, 42(6): 788-793.
19.	Gietelink L, Wouters MW, Bemelman WA, et al. Reduced 30-day mortality after laparoscopic colorectal cancer surgery: A population based study from the Dutch Surgical Colorectal Audit (DSCA). Ann Surg, 2016, 264(1): 135-140.
20.	Watt DG, McSorley ST, Park JH, et al. A postoperative systemic inflammation score predicts short- and long-term outcomes in patients undergoing surgery for colorectal cancer. Ann Surg Oncol, 2017, 24(4): 1100-1109.
21.	Hu WH, Chen HH, Lee KC, et al. Assessment of the addition of hypoalbuminemia to ACS-NSQIP surgical risk calculator in colorectal cancer. Medicine (Baltimore), 2016, 95(10): e2999.

1. Abraha I, Serraino D, Giovannini G, et al. Validity of ICD-9-CM codes for breast, lung and colorectal cancers in three Italian administrative healthcare databases: a diagnostic accuracy study protocol. BMJ Open, 2016, 6(3): e010547.
2. Chang YT, Huang MY, Yeh YS, et al. A prospective study of comparing multi-gene biomarker chip and serum carcinoembryonic antigen in the postoperative surveillance for patients with stage Ⅰ−Ⅲ colorectal cancer. PLoS One, 2016, 11(10): e0163264.
3. 中华医学会呼吸病学分会. 医院获得性肺炎诊断和治疗指南(草案). 中华结核和呼吸杂志, 1999, 22(4): 201-203.
4. Dilworth JP, White RJ. Postoperative chest infection after upper abdominal surgery: an important problem for smokers. Respir Med, 1992, 86(3): 205-210.
5. 于善海, 李德生, 伊力亚尔·夏合丁, 等. 食管癌切除术后并发症多因素Logistic回归分析及风险模型建立. 世界华人消化杂志, 2011, 19(34): 3508-3513.
6. Kim JY, Park IJ, Kim HR, et al. Post-pulmonary metastasectomy prognosis after curative resection for colorectal cancer. Oncotarget, 2017, 8(22): 36566-36577.
7. Samuelsson KS, Egenvall M, Klarin I, et al. Inappropriate drug use in elderly patients is associated with prolonged hospital stay and increased postoperative mortality after colorectal cancer surgery: a population-based study. Colorectal Dis, 2016, 18(2): 155-162.
8. 许钊荣, 池畔. 腹腔镜与开腹结直肠癌根治术后并发症发生率的比较. 中华胃肠外科杂志, 2012, 15(8): 810-813.
9. Couwenberg AM, Burbach MJ, Smits AB, et al. The impact of retractor SPONGE-assisted laparoscopic surgery on duration of hospital stay and postoperative complications in patients with colorectal cancer (SPONGE trial): study protocol for a randomized controlled trial. Trials, 2016, 17(1): 132.
10. Matsuda M, Tsuruta M, Hasegawa H, et al. Transanal drainage tube placement to prevent anastomotic leakage following colorectal cancer surgery with double stapling reconstruction. Surg Today, 2016, 46(5): 613-620.
11. Casal Núñez JE, Vigorita V, Ruano Poblador A, et al. Presacral venous bleeding during mobilization in rectal cancer. World J Gastroenterol, 2017, 23(9): 1712-1719.
12. Sakari T, Sjödahl R, Påhlman L, et al. Role of icodextrin in the prevention of small bowel obstruction. Safety randomized patients control of the first 300 in the ADEPT trial. Colorectal Dis, 2016, 18(3): 295-300.
13. McSorley ST, Horgan PG, McMillan DC. The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol, 2016, 97: 168-177.
14. Yaegashi M, Otsuka K, Kimura T, et al. Transumbilical abdominal incision for laparoscopic colorectal surgery does not increase the risk of postoperative surgical site infection. Int J Colorectal Dis, 2017, 32(5): 715-722.
15. Yamada T, Okabayashi K, Hasegawa H, et al. Age, preoperative subcutaneous fat area, and open laparotomy are risk factors for incisional hernia following colorectal cancer surgery. Ann Surg Oncol, 2016, 23(Suppl 2): S236-S241.
16. Floodeen H, Hallböök O, Hagberg LA, et al. Costs and resource use following defunctioning stoma in low anterior resection for cancer-A long-term analysis of a randomized multicenter trial. Eur J Surg Oncol, 2017, 43(2): 330-336.
17. McSorley ST, Khor BY, MacKay GJ, et al. Examination of a CRP first approach for the detection of postoperative complications in patients undergoing surgery for colorectal cancer: A pragmatic study. Medicine (Baltimore), 2017, 96(7): e6133.
18. Anderin K, Gustafsson UO, Thorell A, et al. The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer. Eur J Surg Oncol, 2016, 42(6): 788-793.
19. Gietelink L, Wouters MW, Bemelman WA, et al. Reduced 30-day mortality after laparoscopic colorectal cancer surgery: A population based study from the Dutch Surgical Colorectal Audit (DSCA). Ann Surg, 2016, 264(1): 135-140.
20. Watt DG, McSorley ST, Park JH, et al. A postoperative systemic inflammation score predicts short- and long-term outcomes in patients undergoing surgery for colorectal cancer. Ann Surg Oncol, 2017, 24(4): 1100-1109.
21. Hu WH, Chen HH, Lee KC, et al. Assessment of the addition of hypoalbuminemia to ACS-NSQIP surgical risk calculator in colorectal cancer. Medicine (Baltimore), 2016, 95(10): e2999.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

结直肠癌术后并发症的风险预测模型

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