高龄食管癌患者手术并发症预测的临床研究

Clinical Study on Predicting Surgical Complications in Elderly Patients with Esophageal Cancer

目的探析生理能力与手术应激评分系统(E-PASS)预测和评价高龄食管癌患者潜在的手术风险和术后并发症的影响因素。方法以该院胸外科自2012年6月—2018年6月收治的154例高龄食管癌患者为研究对象,分析E-PASS评分系统预测食管癌患者术后发生并发症的价值。结果 154例食管癌患者中有35例术后出现并发症,占22.73%。将所有患者分为并发症组和非并发症组发现,并发症组SSS(0.48±0.11)分、PRS(0.34±0.06)分、CRS(0.46±0.12)分,均显著高于非并发症组(t_1=9.062,t_2=7.518,t_3=11.260,P=0.000)。且E-PASS评分对食管癌患者的术后并发症发生预测的ROC曲线下面积分别为0.868(SSS)、0.788(PRS)、0.931(CRS)(P=0.000)。单因素方差分析,体能状态指数、年龄、既往心脏病史、糖尿病史、脑血管病史和ASA分级结果是影响食管癌患者术后并发症发生的重要影响因素。结论 E-PASS评分可以很好的预测高龄食管癌患者术后并发症发生,且患者的体能状态指数、年龄、既往心脏病史、糖尿病史和ASA系统的分级结果是影响高龄食管癌患者术后并发症发生的重要影响因素,应加强对上述高危人群的术后监测与防范,最大限度减少并发症发生。

Objective To analyze the physiological ability and surgical stress scoring system(E-PASS)to predict and evaluate the potential surgical risk and postoperative complications of elderly patients with esophageal cancer.Methods A total of 154 elderly patients with esophageal cancer who underwent surgery from June 2012 to June 2018 in our hospital were included in the study.The E-PASS scoring system was used to predict the postoperative complications of esophageal cancer patients.Results Of the 154 patients with esophageal cancer,35 had postoperative complications,accounting for 22.73%.All patients were divided into the complication group and the non-complication group.The SSS(0.48±0.11)points,PRS(0.34±0.06)points,and CRS(0.46±0.12)points were significantly higher in the complication group than in the non-complication group(t1=9.062,t2=7.518,t3=11.260,P=0.000).The areas under the ROC curve for predicting postoperative complications of esophageal cancer patients with E-PASS score were 0.868(SSS),0.788(PRS),and 0.931(CRS)(P=0.000).One-way analysis of variance,physical status index,age,past history of heart disease,history of diabetes,history of cerebrovascular disease,and ASA grading were important factors influencing postoperative complications in patients with esophageal cancer.Conclusion The E-PASS score can predict the postoperative complications of elderly patients with esophageal cancer.The physical status index,age,history of previous heart disease,history of diabetes and ASA system are the results of postoperative complications in elderly patients with esophageal cancer.The important influencing factors of the disease should strengthen the postoperative monitoring and prevention of the above-mentioned high-risk groups,and minimize the occurrence of complications.