个体化预测腹腔镜下结直肠癌根治术后发生吻合口瘘的风险预警模型的建立与验证

Establishment and validation of an individualized risk prediction model for anastomotic leakage after laparoscopic radical resection for colorectal cancer

目的探讨腹腔镜下结直肠癌根治术后发生吻合口瘘的危险因素,并构建腹腔镜下结直肠癌根治术后发生吻合口瘘的列线图模型。方法选取2018年1月至2020年12月于德阳市人民医院行腹腔镜下结直肠癌根治术的445例结直肠癌患者作为研究对象。应用Logistic回归分析筛选腹腔镜下结直肠癌根治术后发生吻合口瘘的危险因素,应用R软件建立腹腔镜下结直肠癌根治术后发生吻合口瘘的列线图模型,并验证该模型。结果445例结直肠癌患者中有43例患者术后发生吻合口瘘,吻合口瘘的发生率为9.66%。Logistic回归分析结果显示,术前白蛋白水平<35 g/L、术前肠梗阻、肿瘤距肛门边缘距离<7 cm及合并糖尿病为腹腔镜下结直肠癌根治术后发生吻合口瘘的危险因素(P<0.05)。腹腔镜下结直肠癌根治术后发生吻合口瘘的列线图模型的校准曲线显示模型的预测值和实际值拟合度良好,模型的曲线下面积为0.801(95%CI:0.761~0.841)。结论术前白蛋白水平<35 g/L、术前肠梗阻、肿瘤距肛门边缘距离<7 cm等合并糖尿病为腹腔镜下结直肠癌根治术后发生吻合口瘘的危险因素,腹腔镜下结直肠癌根治术后发生吻合口瘘的列线图模型具有较高的准确性。

【Objective】To explore the risk factors of anastomotic leakage after laparoscopic radical resection of colorectal cancer,and to construct an nomograph model of anastomotic leakage after laparoscopic radical resection of colorectal cancer.【Methods】From January 2018 to December 2020,445 colorectal cancer patients who underwent laparoscopic colorectal cancer radical surgery in our hospital were selected as the study subjects.Logistic regression analysis was used to screen the risk factors of anastomotic leakage after laparoscopic colorectal cancer radical surgery,and R software was used to establish the nomogram model of anastomotic leakage after laparoscopic colorectal cancer radical surgery,and verify the model.【Results】Among 445 colorectal cancer patients,43 patients had anastomotic leakage after operation,and the incidence of anastomotic leakage was 9.66%.Logistic regression analysis showed that preoperative albumin level<35g/L,preoperative intestinal obstruction,tumor with anal margin<7cm,and diabetes were the risk factors for anastomotic leakage after laparoscopic radical resection of colorectal cancer(P<0.05).The calibration curve of the nomograph model of anastomotic leakage after laparoscopic colorectal cancer radical surgery showed that the predicted value of the model was well matched with the actual value,and the area under the curve of the model was 0.801(95%CI:0.761–0.841).【Conclusion】The risk factors of anastomotic leakage after laparoscopic radical resection of colorectal cancer were diabetes,preoperative albumin level<35g/L,preoperative intestinal obstruction,tumor with anal margin distance<7cm,etc.The nomogram model of anastomotic leakage after laparoscopic radical resection of colorectal cancer had high accuracy.