腹腔镜脾切除术难度评分系统对围手术期安全性的预测价值

Value of difficulty scoring system in predicting perioperative safety of laparoscopic splenectomy

目的探讨腹腔镜脾切除术(LS)难度评分系统对术中发生不良事件及术后并发症的预测价值。方法回顾性分析2009年1月至2015年12月在西安交通大学第一附属医院行LS的202例非创伤性疾病患者临床资料。其中男97例,女105例;年龄12~75岁,中位年龄46岁。患者均签署知情同意书,符合医学伦理学规定。根据LS难度评分系统评分将患者分为低难度组(64例)、中难度组(54例)和高难度组(84例)。观察术中不良事件和术后并发症发生情况。率的比较采用χ2检验或Fisher确切概率法。采用Spearman相关系数分析难度评分与术中不良事件、术后并发症的相关性。采用受试者工作特征(ROC)曲线评估预测效能。结果难度评分系统与手术时间、术中出血量及术后并发症发生有关(χ^2=11.517,6.521,22.526;P<0.05),而与中转开腹率无关(χ^2=0.097,P>0.05)。难度评分系统与手术时间、术后并发症发生率成正相关(rs=0.273,0.324;P<0.05),而与术中出血量、中转开腹率无明显相关(rs=0.085,0.106;P>0.05)。难度评分系统对术中不良事件预测的ROC曲线下面积为0.593,95%CI:0.513~0.673。结论LS手术难度评分系统并不能很好地预测我国LS术中不良事件和术后并发症的发生,需建立适合国人应用的LS难度评分系统。

Objective To evaluate the difficulty scoring system for laparoscopic splenectomy(LS)in predicting the intraoperative adverse events and postoperative complications.Methods Clinical data of 202 patients with non-traumatic diseases who underwent LS in the First Affiliated Hospital of Xi'an Jiaotong University from January 2009 to December 2015 were retrospectively analyzed.Among them,97 cases were male and 105 female,aged from 12 to 75 years old with a median age of 46.The informed consents of all patients were obtained and the local ethical committee approval was received.According to the difficulty scoring system for LS,all the patients were divided into the low-difficulty group(n=64),medium-difficulty group(n=54)and high-difficulty group(n=84).Intraoperative adverse events and postoperative complications were observed.The rate comparison was performed by Chi-square test or Fisher exact probability.The correlation between difficulty score and intraoperative adverse events,postoperative complications was assessed by Spearman correlation coefficient.The prediction efficiency was evaluated by receiver operating characteristic(ROC)curve.Results The difficulty scoring system was significantly correlated with the operation time,intraoperative blood loss and postoperative complications(χ^2=11.517,6.521,22.526;P<0.05),whereas not associated with the conversion rate of open surgery(χ^2=0.097,P>0.05).The difficulty scoring system was significantly positively correlated with the operation time and incidence of postoperative complications(rs=0.273,0.324;P<0.05),whereas not associated with the intraoperative blood loss or conversion rate of open surgery(rs=0.085,0.106;P>0.05).The area under ROC curve of difficulty scoring system for predicting the intraoperative adverse events was 0.593(95%CI:0.513-0.673).Conclusions Difficulty scoring system for LS cannot accurately predict the incidence of intraoperative adverse events and postoperative complications of LS in China.It is necessary to establish a difficulty scoring system for LS suitable for the Chinese population.