消化系统恶性肿瘤患者腹腔镜术后静脉血栓栓塞症发生的危险因素分析与预测模型的建立

Analysis of risk factors and establishment of predictive models for postoperative venous thromboembolism in patients with malignant tumors of the digestive system undergoing laparoscopic surgery

目的分析消化系统恶性肿瘤患者腹腔镜术后静脉血栓栓塞症(venous thromboembolism,VTE)发生的危险因素,并建立VTE发生的诺谟图预测模型。方法回顾性分析2018年1月至2023年1月赤峰学院附属医院腹腔镜手术治疗的2103例消化系统恶性肿瘤患者的临床资料,其中1975例患者术后未发生VTE(非VTE组),128例患者术后发生VTE(VTE组)。应用Logistic回归分析确定腹腔镜手术后VTE发生的危险因素,制作诺谟图建立相关预测模型。结果多因素分析显示,年龄>60岁[风险比(odds ratio,OR)=2.112,95%置信区间(confidence interval,CI)=1.662~2.486]、身体质量指数>30 kg/m^(2)(OR=1.512,95%CI=1.013~1.663)、VTE病史(OR=1.496,95%CI=1.598~1.592)、手术时间>240 min(OR=1.339,95%CI=1.298~1.669)、术中输血(OR=1.337,95%CI=1.289~1.432)和下床活动时间>48 h(OR=1.185,95%CI=1.054~1.331)是消化系统恶性肿瘤腹腔镜手术后VTE发生独立危险因素(P<0.05)。诺谟图预测模型的受试者工作特征曲线下面积为0.751(95%CI=0.708~0.794),敏感度和特异度分别为0.772和0.605,具有良好的预测价值(P<0.05)。结论消化系统恶性肿瘤患者腹腔镜术后VTE的发生与年龄、肥胖、VTE病史、手术时间、术中输血及术后下床活动时间相关,术前应充分评估以降低术后VTE的发生率。

Objective To analyze the risk factors for postoperative venous thromboembolism(VTE)in patients with malignant tumors of the digestive system undergoing laparoscopic surgery,and to establish a Nomogram prediction model for the occurrence of VTE.Methods The clinical data of 2103 patients with malignant tumors of the digestive system who underwent laparoscopic surgery at Chifeng College Affiliated Hospital from January 2018 to January 2023 were analyzed retrospectively.Among them,1975 patients did not experience VTE after surgery(non-VTE group),while 128 patients developed VTE after surgery(VTE group).Logistic regression analysis was used to determine the risk factors for VTE after laparoscopic surgery,and Nomogram model was made to establish a relevant prediction model.Results Multivariate analysis showed that age>60 years old[odds ratio(OR)=2.112,95%confidence interval(CI)=1.662-2.486],body mass index>30 kg/m^(2)(OR=1.512,95%CI=1.013-1.663),history of VTE(OR=1.496,95%CI=1.598-1.592),operation time>240 min(OR=1.339,95%CI=1.298-1.669),intraoperative blood transfusion(OR=1.337,95%CI=1.289-1.432)and duration of getting out of bed>48 h(OR=1.185,95%CI=1.054-1.331)were independent risk factors for the occurrence of VTE after laparoscopic surgery for malignant tumors of the digestive system(P<0.05).The area under curve of receiver operating characteristic curve of the Nomogram prediction model was 0.751(95%CI=0.708-0.794),and the sensitivity and specificity were 0.772 and 0.605,respectively,which had good predictive value(P<0.05).Conclusion The occurrence of VTE after laparoscopic surgery in patients with digestive system malignant tumors is related to age,obesity,VTE history,operation time,intraoperative blood transfusion and postoperative ambulation time.Preoperative evaluation should be sufficient to reduce the incidence of postoperative VTE.