腹腔镜下右半结肠癌根治术后胃肠功能障碍的高危因素分析及预测模型的建立

Establishment of high risk factors and predictive model of gastrointestinal dysfunction after laparoscopic surgery for right colon cancer

目的探讨腹腔镜下右半结肠癌根治术术后发生胃肠功能紊乱的危险因素,并建立胃肠功能紊乱的风险预测模型。方法回顾性分析我院胃肠外科2016年1月~2019年4月收治的161例行腹腔镜下右半结肠癌根治术病人的临床资料,应用单因素及多因素分析,确定术后胃肠功能紊乱发生的独立危险因素,并以此建立风险预测模型,通过受试者工作特征曲线(ROC)及曲线下面积(AUC)计算其灵敏度和特异度。结果术后胃肠功能紊乱发病率为17.3%,多因素分析结果显示,术前营养不良(P<0.05)和术前不完全性肠梗阻(P<0.05)为术后出现胃肠功能紊乱的独立危险因素,胃肠功能紊乱的预测模型ROC曲线下面积0.750(95%CI:0.658~0.841),曲线对应的灵敏度为0.786,特异度为0.639。结论术前营养不良和不完全性肠梗阻为腹腔镜下右半结肠癌根治术后胃肠功能紊乱发生的独立危险因素,建立的术后预测模型灵敏度、特异度较高,可为术后胃肠功能紊乱的预测提供参考。

Objective To explore the risk factors of gastrointestinal dysfunction after laparoscopic radical resection of right colon cancer,and to establish a risk prediction model for intestinal dysfunction.Methods The clinical data of 161 patients undergoing laparoscopic radical resection of right colon cancer were analyzed retrospectively from January 2016 to April 2019 in the department of gastrointestinal surgery,Renmin Hospital of Wuhan University.The independent risk factors for the occurrence of gastrointestinal dysfunction after operation were determined by single factor and multi-factor analysis.The sensitivity and specificity of ROC and AUC were calculated.Results The incidence of gastrointestinal dysfunction was 17.3%.Multivariate analysis showed that preoperative malnutrition(P<0.05)and preoperative incomplete intestinal obstruction(P<0.05)were independent risk factors for postoperative gastrointestinal dysfunction.Based on this,a predictive model of postoperative gastrointestinal dysfunction was established.The area under ROC curve was 0.750(95% CI:0.658~0.841).The sensitivity and specificity of the curve were 0.786 and 0.639,respectively.Conclusion Preoperative malnutrition and preoperative incomplete intestinal obstruction are independent risk factors for gastrointestinal dysfunction after laparoscopic radical resection of right colon cancer.The sensitivity and specificity of the established prediction model are high,which can provide reference for the prediction of gastrointestinal dysfunction after laparoscopic radical resection of right colon cancer.