腹腔镜直肠癌前切除术难易程度评分系统的初步建立与应用

Establishment and application of a scoring system for predicting the difficulty level of laparoscopic anterior resection for rectal cancer

目的根据术前临床资料初步建立预测腹腔镜直肠癌前切除术(LAR)难易程度的评分系统。方法对2012年1月-2014年5月于佛山市第二人民医院实施腹腔镜直肠癌前切除术的120例患者术前临床资料进行单因素分析,筛选出可能影响手术难度的危险因素,然后对危险因素进行Logistic多元回归分析,并对各危险因素分别赋值,建立预测LAR难易程度的评分系统。用ROC曲线评价该评分系统的效能。2014年6月-2014年8月LAR 30例运用该评分系统进行评分,比较评分结果与实际手术难度的差异。结果男性、BMI≥28 kg/m2、肿瘤长径≥4.0 cm、肿瘤距肛缘距离<6.0 cm、深窄骨盆(骨盆坐骨棘间径<9.6 cm、骨盆骶尾间距≥11.8 cm)是影响手术难度的危险因素,根据上述因素建立LAR难易程度的评分系统,得分越高,手术难度越大。ROC曲线下面积为0.947,应用评分系统对LAR 30例评分,其评估手术难度与实际难度总体相符率达86.7%。结论 LAR难易度评分系统的建立有利于术前筛选病例,为医疗风险评估提供量化指标。

[ Objective ] To establish a scoring system for predicting the difficulty level of laparoscopic anterior resection （LAR） for rectal cancer based on preoperative clinical data. [ Methods ] Univariable analysis was performed for the preoperative clinical data of the 120 cases receiving LAR in our hospital from January 2012 to May 2014. Multiple logistic regression was performed to identify risk factors that were subsequently scored. A scoring system for predicting the difficulty level of LAR was then established. The value of this scoring system was evaluated using ROC curve analysis. The scoring system was then used in 30 cases undergoing LAR at our hospital from June 2014 to August 2014 to compare with the real situation of each operation. [Results ] The risk factors influencing the diffi- culty level of LAR included male, body mass index （BMI） ≥ 28 kg/m2, diameter of tumor t〉 4cm, distance between the tumor and the anal edge 〈 6 cm, the deep and narrow pelvis （the interspinous distance 〈 9.6 cm, the distance from sacral promontory to the tip of coccyx ≥ 11.8 cm）. According to the established scoring system, a higher score was associated with a more difficult operation. The area below ROC curve was 0.947. When the scoring system was used in 30 cases undergoing LAR, the total coincidence ratio was 86.7% between predicted and actual difficulty. [ Conclusion ] The establishment of the scoring system is clinically helpful for the preoperative screening cases and health risk assessment.