腹腔镜胃癌切除术经阴道取标本手术可行性预测列线图的构建与验证

Construction and verification of feasibility prediction nomogram for laparoscopic transvaginal natural orifice specimen extraction surgery of gastric cancer

目的建立列线图预测腹腔镜胃癌切除术经阴道取标本手术(Tv-NOSES)的可行性。方法收集2022年1月至2023年8月在急诊外科接受腹腔镜胃癌切除术的25例女性患者为研究对象,根据是否成功经阴道取出标本将患者分为成功组与失败组。收集患者的临床数据,分析影响胃癌患者Tv-NOSES可行性的因素,并建立预测Tv-NOSES可行性的受试者工作特征(ROC)曲线及列线图。结果25例患者中,15例标本成功经阴道取出,10例标本经上腹正中小切口取出。单因素分析结果显示,两组的手术方式、TNM分期、美国麻醉医师协会(ASA)分级、年龄、坐骨结节间径、手术时间、出血量、癌胚抗原(CEA)、糖类抗原199(CA199)水平比较,差异无统计学意义(P>0.05);两组的病灶大小、身体质量指数(BMI)、ROD比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,BMI、ROD是影响胃癌患者Tv-NOSES可行性的独立因素(P<0.05)。ROC曲线结果显示曲线下面积为0.907。根据多因素Logistic回归方程的预测模型得到可以预测成功经阴道取标本可能性的列线图,将BMI与ROD代入可得到胃癌患者Tv-NOSES的成功概率。结论BMI、ROD越小提示标本更容易经阴道取出,二者可预测腹腔镜胃癌切除术Tv-NOSES的可行性。

Objective To establish a nomogram to predict the feasibility of transvaginal natural orifice specimen extraction surgery(Tv-NOSES)for laparoscopic gastrectomy.Methods A total of 25 female patients who underwent laparoscopic gastrectomy in emergency surgery department from January 2022 to August 2023 were collected as the research objects.According to whether the specimens were successfully removed by vagina,the patients were divided into success group and failure group.The clinical data of patients were collected to analyze the factors affecting the feasibility of Tv-NOSES in patients with gastric cancer,and the receiver operating characteristic(ROC)curve and nomogram were established to predict the feasibility of Tv-NOSES.Results Among the 25 patients,15 patients specimens were successfully removed through vagina,and 10 patients specimens were removed through a small incision in the middle of the upper abdomen.Univariate analysis showed that there were no significant differences in surgical methods,TNM staging,American Society of Anesthesiologists(ASA)classification,age,diameter between ischial nodules,operation time,bleeding volume,carcinoembryonic antigen(CEA)and carbohydrate antigen 199(CA199)levels between the two groups(P>0.05);there were statistically significant differences in lesion size,body mass index(BMI)and ROD between the two groups(P<0.05).Multivariate Logistic regression analysis showed that BMI and ROD were independent factors affecting the feasibility of Tv-NOSES in patients with gastric cancer(P<0.05).The ROC curve showed that the area under the curve was 0.907.According to the prediction model of multivariate Logistic regression equation,a nomogram that can predict the possibility of successful transvaginal specimen extraction was obtained.The success rate of Tv-NOSES in patients with gastric cancer can be obtained by substituting BMI and ROD.Conclusion The smaller the BMI and ROD,the easier it is to remove the specimen through the vagina,and both can predict the feasibility of Tv-NOSES in laparoscopic gastrectomy.