中国全科医学Issue(30)：3545-3549,5.DOI:10.3969/j.issn.1007-9572.2014.30.005
腹腔镜辅助直肠癌手术中转开腹的危险因素分析及预测模型建立
Analysis of Risk Factors for Convertion to Laparotomy in Laparoscopic Assisted Colorectal Surgery and Establishment of ;the Prediction Model
摘要
Abstract
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.关键词
直肠肿瘤/腹腔镜检查/危险因素/预测/模型,统计学Key words
Rectal neoolasms/Laparoscopy/Risk factors/Forecasting/Models,statistical分类
医药卫生引用本文复制引用
钟武,张磊昌,钟世彪,江志远,陈利生..腹腔镜辅助直肠癌手术中转开腹的危险因素分析及预测模型建立[J].中国全科医学,2014,(30):3545-3549,5.基金项目
国家自然科学基金资助项目 （）
