胃癌腹腔镜根治术后肺部感染的Clavien-Dindo分级、高危因素及预防措施分析

Clavien-Dindo classification,high-risk factors and preventive measures of pulmonary infection in patients with gastric cancer after laparoscopic radical surgery

目的 探讨胃癌腹腔镜根治术后肺部感染的Clavien-Dindo分级情况、危险因素及预防措施,并构建预测模型。方法 回顾性选取2021年7月至2023年7月于本院接受腹腔镜根治术治疗的268例胃癌患者。以其术后肺部感染情况分为感染组与未感染组,分别为33例、235例。采用单因素、多因素分析其术后发生肺部感染的高危因素,根据所筛选出的高危因素进行预测模型构建,并绘制受试者工作特征曲线(ROC),对该模型的胃癌患者腹腔镜根治术后肺部感染预测价值进行分析,获取其曲线下面积(AUC)、敏感度、特异度。结果 268例胃癌患者中33例发生术后肺部感染,感染率为12.31%。Clavien-Dindo分级主要集中为Ⅱ级。经单因素、多因素分析,胃癌患者腹腔镜根治术后肺部感染的高危因素为年龄≥65岁、胃管留置时间≥3 d、术前血清白蛋白水平低(OR分别为3.449、3.180、2.824,P<0.05)。构建回归模型并按照预测概率logit(P)绘制ROC曲线,当logit(P)>12.95时,AUC值为0.897,敏感度为84.85%,特异度为78.72%,预测价值良好。结论 年龄≥65岁、胃管留置时间≥3 d、术前血清白蛋白水平低为胃癌患者腹腔镜根治术后肺部感染的危险因素,据此构建回归模型的预测价值较高,临床可对发生术后肺部感染的高危群体进行针对性干预以降低其感染风险。

Objective To explore the Clavien-Dindo classification and risk factors and preventive measures of pulmonary infection in patients with gastric cancer after laparoscopic radical surgery,and to construct a prediction model.Methods From July 2021 to July 2023,268patients with gastric cancer who received laparoscopic radical surgery in our hospital were selected retrospectively.According to whether postoperative pulmonary infection occurred,they were divided into the uninfected group(235 cases) and the infected group(33 cases).Single-factor and multivariate Logistic regression analysis were used to analyze the risk factors of postoperative pulmonary infection.According to the results of multivariate Logistic regression analysis,a prediction model was constructed,and the predictive value of receiver operating characteristic curve(ROC)analysis prediction model for pulmonary infection after laparoscopic radical gastrectomy in patients with gastric cancer,and its area under curve(AUC),sensitivity and specificity were obtained.Results Among 268 cases of gastric cancer,33 cases developed postoperative pulmonary infection,and the infection rate was 12.31%.Clavien-Dindo classification mainly concentrated in Grade Ⅱ.Multivariate Logistic regression analysis showed that,age ≥65 years,Gastric tube indwelling time ≥3 d,low preoperative serum albumin level were the risk factors for pulmonary infection in patients with gastric cancer after laparoscopic radical surgery(OR=3.449、3.180、2.824,P<0.05).According to the predicted probability logit(P),the ROC curve of pulmonary infection after laparoscopic radical gastrectomy in patients with gastric cancer.When logit(P)>12.95,the AUC value was0.897,the sensitivity was 84.85%,and the specificity was 78.72%,the forecast value was good.Conclusion Age ≥65 years,Gastric tube indwelling time ≥3 d,low preoperative serum albumin level are the risk factors for pulmonary infection in patients with gastric cancer after laparoscopic radical surgery.Based on this,the regression model is of high predictive value,and the high-risk groups of postoperative pulmonary infection can be intervened in clinic to reduce their infection risk.