老年结肠癌患者择期结肠切除术后吻合口漏的影响因素分析及预测模型构建

Analysis of risk factors and construction of a nomogram predictive model for anastomotic leakage after elective colectomy in elderly patients with colon cancer

目的确定老年结肠癌患者择期结肠切除术后吻合口漏发生的危险因素,并建立术后吻合口漏发生风险的预测模型。方法回顾性分析2018年1月至2021年12月期间在兰州大学第一医院择期接受结肠癌手术治疗的122例65岁以上老年患者的临床资料。采用单因素分析和多因素logistic回归分析吻合口漏发生的潜在危险因素,根据确定的独立危险因素建立列线图预测模型,并通过受试者工作特征曲线评价模型的预测效能。结果本研究纳入的122例患者中术后发生吻合口漏10例,未发生吻合口漏112例。单因素分析结果显示:吻合口漏的发生与体质量指数、吸烟、合并糖尿病、年龄校正Charlson合并症指数、术中及术后2 d内输血、术前血红蛋白、术前白蛋白和术前预后营养指数有关(P<0.05);多因素logistic回归分析结果显示:吸烟[OR=15.529,95%CI为(1.529,157.690),P=0.020]、年龄校正Charlson合并症指数[OR=1.742,95%CI为(1.024,2.966),P=0.041]和术中及术后2 d内输血[OR=82.223,95%CI为(1.265,5343.025),P=0.038]被确定为吻合口漏发生的独立危险因素。根据3个独立危险因素建立列线图预测模型,该模型的受试者工作特征曲线下面积为0.897[95%CI为(0.804,0.990)],其校正后一致性指数为0.881,提示该模型对吻合口漏发生风险的预测能力较好。结论吸烟、较高的年龄校正Charlson合并症指数和术中及术后2 d内输血是择期接受结肠癌切除术的老年患者术后发生吻合口漏的重要影响因素,3种因素联合构建的列线图预测模型有助于外科医生优化治疗决策和术后监测。

Objective To determine the risk factors of anastomotic leakage after elective colectomy in elderly patients with colon cancer,and to establish a model for predicting the risk of postoperative anastomotic leakage based on these factors.Methods The clinical data of 122 over 65 years old elderly patients who underwent colon cancer surgery in the First Hospital of Lanzhou University from January 2018 to December 2021 were analyzed retrospectively.Single factor analysis and multivariate logistic regression were used to analyze the potential risk factors for anastomotic leakage.A nomogram predictive model was established based on the determined independent risk factors,and the predictive performance of the model was evaluated by the receiver operating characteristic curve.Results Among the 122 patients included in this study,10 had postoperative anastomotic leakage and 112 had no anastomotic leakage.Single factor analysis results showed that the occurrence of anastomotic leakage was associated with body mass index,smoking,combined diabetes,age-adjusted Charlson comorbidity index,intraoperative and postoperative blood transfusion within 2 days,preoperative hemoglobin,preoperative albumin,and preoperative prognostic nutritional index(P<0.05).The results of multivariate logistic regression analysis showed that smoking[OR=15.529,95%CI(1.529,157.690),P=0.020],age-adjusted Charlson comorbidity index[OR=1.742,95%CI(1.024,2.966),P=0.041],and intraoperative and postoperative blood transfusion within 2 days[OR=82.223,95%CI(1.265,5343.025),P=0.038]were independent risk factors for anastomotic leakage.A nomogram predictive model was established based on three independent risk factors.The area under the receiver operating characteristic curve of the model was 0.897[95%CI(0.804,0.990)],and its corrected C-index value was 0.881,indicating that the model had good predictive ability for the risk of anastomotic leakage.Conclusions Smoking,higher age-adjusted Charlson comorbidity index,and intraoperative and postoperative blood transfusion within 2 days are important risk factors for anastomotic leak in elderly patients undergoing elective colon cancer resection.This nomogram predictive model based on the combination of the three factors is helpful for surgeons to optimize treatment decisions and postoperative monitoring.