中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
30期
3545-3549
,共5页
钟武%张磊昌%钟世彪%江志远%陈利生
鐘武%張磊昌%鐘世彪%江誌遠%陳利生
종무%장뢰창%종세표%강지원%진리생
直肠肿瘤%腹腔镜检查%危险因素%预测%模型,统计学
直腸腫瘤%腹腔鏡檢查%危險因素%預測%模型,統計學
직장종류%복강경검사%위험인소%예측%모형,통계학
Rectal neoolasms%Laparoscopy%Risk factors%Forecasting%Models,statistical
目的：分析腹腔镜辅助直肠癌手术中转开腹的相关危险因素，建立概率预测模型，以指导临床诊疗。方法收集2005年12月-2013年12月广西医科大学第一附属医院由同一手术团队完成腹腔镜辅助直肠癌手术患者1037例的临床资料，127例行中转开腹手术，中转开腹率为12.25%。采用单因素分析和多因素Logistic回归分析方法，探讨影响中转开腹的危险因素，并用判别分析方法建立概率预测模型。结果1037例腹腔镜手术中，127例中转开腹为开腹组，余910例为腹腔镜组；开腹组手术时间、术后住院时间、术后开始进食时间均长于腹腔镜组（ P<0.05），开腹组术中失血量多于腹腔镜组（ P<0.05），开腹组术后肠梗阻和切口感染率高于腹腔镜组（ P<0.05），两组吻合口瘘和肺部感染发生率差异无统计学意义（ P>0.05）。单因素分析结果显示：肿瘤位置、腹部手术史、肿瘤大小、BMI、TNM分期、是否存在梗阻、侵犯周围器官、远处转移与中转开腹相关（P<0.05）；多因素Logistic回归模型结果显示，腹部手术史、肿瘤大小、BMI、TNM分期、梗阻、侵犯周围器官进入回归模型（ P<0.05）；建立腹腔镜辅助直肠癌手术中转开腹的概率预测模型：P=eY/（1+eY），Y=-3.873+3.231伊X1+1.025伊X2+1.866伊X3+0.982伊X4+3.137伊X5+2.381伊X6，灵敏度为74.02%，特异度为76.04%。结论腹部手术史、肿瘤大小、BMI、TNM分期、梗阻、侵犯周围器官是腹腔镜辅助直肠癌手术中转开腹的危险因素，术前正确评估腹腔镜辅助直肠癌手术中转开腹的危险因素，可减少中转开腹率。
目的：分析腹腔鏡輔助直腸癌手術中轉開腹的相關危險因素，建立概率預測模型，以指導臨床診療。方法收集2005年12月-2013年12月廣西醫科大學第一附屬醫院由同一手術糰隊完成腹腔鏡輔助直腸癌手術患者1037例的臨床資料，127例行中轉開腹手術，中轉開腹率為12.25%。採用單因素分析和多因素Logistic迴歸分析方法，探討影響中轉開腹的危險因素，併用判彆分析方法建立概率預測模型。結果1037例腹腔鏡手術中，127例中轉開腹為開腹組，餘910例為腹腔鏡組；開腹組手術時間、術後住院時間、術後開始進食時間均長于腹腔鏡組（ P<0.05），開腹組術中失血量多于腹腔鏡組（ P<0.05），開腹組術後腸梗阻和切口感染率高于腹腔鏡組（ P<0.05），兩組吻閤口瘺和肺部感染髮生率差異無統計學意義（ P>0.05）。單因素分析結果顯示：腫瘤位置、腹部手術史、腫瘤大小、BMI、TNM分期、是否存在梗阻、侵犯週圍器官、遠處轉移與中轉開腹相關（P<0.05）；多因素Logistic迴歸模型結果顯示，腹部手術史、腫瘤大小、BMI、TNM分期、梗阻、侵犯週圍器官進入迴歸模型（ P<0.05）；建立腹腔鏡輔助直腸癌手術中轉開腹的概率預測模型：P=eY/（1+eY），Y=-3.873+3.231伊X1+1.025伊X2+1.866伊X3+0.982伊X4+3.137伊X5+2.381伊X6，靈敏度為74.02%，特異度為76.04%。結論腹部手術史、腫瘤大小、BMI、TNM分期、梗阻、侵犯週圍器官是腹腔鏡輔助直腸癌手術中轉開腹的危險因素，術前正確評估腹腔鏡輔助直腸癌手術中轉開腹的危險因素，可減少中轉開腹率。
목적：분석복강경보조직장암수술중전개복적상관위험인소，건립개솔예측모형，이지도림상진료。방법수집2005년12월-2013년12월엄서의과대학제일부속의원유동일수술단대완성복강경보조직장암수술환자1037례적림상자료，127례행중전개복수술，중전개복솔위12.25%。채용단인소분석화다인소Logistic회귀분석방법，탐토영향중전개복적위험인소，병용판별분석방법건립개솔예측모형。결과1037례복강경수술중，127례중전개복위개복조，여910례위복강경조；개복조수술시간、술후주원시간、술후개시진식시간균장우복강경조（ P<0.05），개복조술중실혈량다우복강경조（ P<0.05），개복조술후장경조화절구감염솔고우복강경조（ P<0.05），량조문합구루화폐부감염발생솔차이무통계학의의（ P>0.05）。단인소분석결과현시：종류위치、복부수술사、종류대소、BMI、TNM분기、시부존재경조、침범주위기관、원처전이여중전개복상관（P<0.05）；다인소Logistic회귀모형결과현시，복부수술사、종류대소、BMI、TNM분기、경조、침범주위기관진입회귀모형（ P<0.05）；건립복강경보조직장암수술중전개복적개솔예측모형：P=eY/（1+eY），Y=-3.873+3.231이X1+1.025이X2+1.866이X3+0.982이X4+3.137이X5+2.381이X6，령민도위74.02%，특이도위76.04%。결론복부수술사、종류대소、BMI、TNM분기、경조、침범주위기관시복강경보조직장암수술중전개복적위험인소，술전정학평고복강경보조직장암수술중전개복적위험인소，가감소중전개복솔。
Objective To analyse the risk factors for conversion to laparotomy in laparoscopic assisted colorectal sur-gery,to establish the probabilistic prediction model,and to guide clinical practice. Methods The clinical data of 1 037 patients who underwent laparoscopic assisted colorectal surgery by the same surgical team in the First Affiliated Hospital of Guangxi Medi-cal University from December 2005 to December 2013 were collected,127(12. 25%)patients underwent conversion to laparoto-my,risk factors for conversion to laparotomy were evaluated by chi - square test and Logistic multiple regression analy-sis. Discriminant analysis was used to create the probabilistic prediction model. Results Of the 1 037 patients,127 cases who underwent conversion to laparotomy were selected as convert group,910 cases who underwent laparoscopic surgery were selected as laparoscopic resection group;the operation time,hospital stay and time for dieting in convert group were significantly longer than those in laparoscopic resection group(P<0. 05),and the intraoperative blood loss in convert group was significantly more than that in laparoscopic resection group ( P <0. 05 ), but the intestinal obstruction rate and wound infection rate in convert group were significantly higher than those in the laparoscopic resection group,respectively(P<0. 05),there was no significant difference in anastomotic leakage rate and pulmonary infection rate between two groups( P>0. 05 );univariate analysis results showed that tumor location,abdominal operation history,size of tumor,BMI,TNM stage,intestinal obstruction,invasion of adjacent organs and distant metastasis were correlated to the conversion to laparotomy( P<0. 05 );the multivariate Logistic re-gression analysis results showed that abdominal operation history,size of tumor,BMI,TNM stage,intestinal obstruction and in-vasion of adjacent organs entered the model(P<0. 05);then we established the probabilistic prediction model for conversion to laparotomy in laparoscopic assisted colorectal surgery:P=eY/(1+eY ),Y= -3. 873+3. 231íX1+1. 025íX2+1. 866íX3+0. 982íX4+3. 137íX5+2. 381íX6,the sensitivity was 74. 02%,and specificity was 76. 04%. Conclusion The risk factors for conversion to laparotomy in laparoscopic assisted colorectal surgery include abdominal operation history,size of tumor, BMI,TNM stage,intestinal obstruction and invasion of adjacent organs. If risk factors for conversion to laparotomy in laparoscop-ic assisted colorectal surgery are evaluated correctly before surgery,the rate of conversion to laparotomy may be reduced.
