腹腔镜阑尾切除术难易程度评分系统的建立和应用

Establishment and application of a scoring system for predicting the difficulty level of laparoscopic appendectomy

目的:分析影响腹腔镜阑尾切除术(LA)难易程度的危险因素,建立预测LA难易程度的评分系统.方法:回顾性分析承德医学院附属医院2001-07/2009-08行LA手术1276例的临床指标.运用Logistic多因素回归分析方法筛选影响手术难易程度的危险因素,对各种危险因素分别赋值,建立预测LA难易程度评分系统.用ROC曲线评价该评分系统的效能,2009-09/2010-05LA122例运用该评分系统进行评分,比较评分结果与实际手术难易度的差异.结果:高龄(≥60岁)、肥胖(体质量指数≥28)、下腹部手术史、右下腹腹膜炎、白细胞计数(≥12×109/L)、发作至手术时间(≥24h)、最高体温(≥38.0℃)、阑尾周围重度粘连、阑尾直径(≥1cm)是影响手术难度的危险因素,建立腹腔镜阑尾切除术难易程度评分系统.得分越高,手术难度越大.ROC曲线下面积为0.952.应用评分系统对LA122例评分,其评估手术难易程度与实际难度总体相符率达87.7%.结论:腹腔镜阑尾切除术难易程度评分系统简单、实用,在临床实践中有重要意义.

AIM：To analyze the risk factors influencing the difficulty level of laparoscopic appendectomy（LA） based on clinical data and to establish a scoring system for predicting the difficulty level of LA.METHODS：The clinical data for 1 276 patients who underwent LA at our hospital from July 2001 to August 2009 were analyzed retrospectively.Multiple logistic regression was performed to identify risk factors that were subsequently scored.A scoring system for predicting the difficulty level of LA was then established.The value of this scoring system was evaluated using ROC curve analysis.The scoring system was then used in 122 patients undergoing LA at our hospital from September 2009 to May 2010 to compare with the real situation of each operation.RESULTS：The risk factors influencing the diff iculty level of LA included age ≥60,body mass index（BMI） ≥28,a history of lower abdominal operation,peritonitis in right lower abdomen,white blood cell（WBC） count ≥12 × 109/L,the time from onset to operation ≥24 h,the highest body temperature ≥38.0 ℃,severe adhesion,and appendiceal diameter ≥1 cm.According to the scoring system established,a higher score is associated with a more difficult operation.The area below ROC curve was 0.952,with a stand error of 0.007.When the scoring system was used in 122 patients undergoing LA,the total coincidence ratio was 87.7% between predicted and actual diff iculty.CONCLUSION：The scoring system established in this study is simple and practical and has important clinical value.