老年食管癌VATS术后颈部吻合口瘘有关影响因素的Logistic回归分析与预测模型构建

doi:10.3969/j.issn.1006-6233.2021.12.029

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摘要 目的: 探讨老年食管癌电视胸腔镜肺癌根治术(VATS)术后颈部吻合口瘘有关影响因素,并建立Logistic回归预测模型。方法: 选取2017年1月至2020年12月南通大学附属医院178例行VATS手术的老年食管癌患者,统计术后颈部吻合口瘘发生率,采用单因素、多因素方式描述老年食管癌VATS术后颈部吻合口瘘影响因素,建立Logistic回归预测模型,并评估该模型预测术后颈部吻合口瘘特异性及敏感性。结果: 178例行VATS手术的老年食管癌患者,术后吻合口瘘发生率为14.04%。Logistic回归方程分析发现,腹部手术史、住院时间≥16d、术后肺部感染、术后应用呼吸机、术后第1天白蛋白水平≥35g/L是老年食管癌患者VATS术后颈部吻合口瘘影响因素(P<0.05)。对Logistic回归模型进行评价,显示模型建立具有统计学意义。Wald检验显示回归方程的系数差异有统计学意义。采用Hosmer-Lemeshow拟合优度检验显示模型拟合效果较好。Logistic回归模型统计分析数据集发现,预测术后颈部吻合口瘘的AUC为0.926,预测敏感度为92.00%,特异度为80.26%。结论: 老年食管癌VATS术后颈部吻合口瘘有关影响因素众多,涉及腹部手术史、肺部感染、住院时间等,根据高危因素构建的Logistic预测模型对老年食管癌VATS术后颈部吻合口瘘具有较高预测价值,有助于指导临床治疗。

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	赵湘
	顾园园
	滕亚莉

关键词 ：食管癌, 老年, 电视胸腔镜肺癌根治术, 颈部吻合口瘘

Abstract：Objective: To investigate the influencing factors of cervical anastomotic leakage after video-assisted thoracoscopic radical resection of lung cancer (VATS) in elderly patients with esophageal cancer, and to establish a logistic regression prediction model. Methods: A total of 178 elderly patients with esophageal cancer who underwent VATS surgery in Nantong University Affiliated Hospital from January 2017 to December 2020 were selected. The incidence of postoperative cervical anastomotic leakage was calculated. A single-factor and multi-factor method was used to describe the postoperative neck of elderly esophageal cancer after VATS. Influencing factors of anastomotic fistula, a Logistic regression prediction model was established, and the specificity and sensitivity of the model for predicting postoperative cervical anastomotic fistula were evaluated. Results: In 178 elderly patients with esophageal cancer who underwent VATS surgery, the incidence of postoperative anastomotic leakage was 14.04%. Logistic regression analysis found that the history of abdominal surgery, hospital stay≥16 d, postoperative lung infection, postoperative ventilator use, and albumin level≥35 g/L on the first day after surgery are VATS in elderly patients with esophageal cancer Factors affecting postoperative cervical anastomotic leakage (P<0.05). Evaluation of the Logistic regression model showed that the model establishment is statistically significant. Wald test showed that the coefficient difference of the regression equation is statistically significant. The Hosmer-Lemeshow goodness-of-fit test showed that the model fits well. Logistic regression model statistical analysis of the data set found that the AUC for predicting postoperative cervical anastomotic leakage was 0.926, the prediction sensitivity was 92.00%, and the specificity was 80.26%. Conclusion: There are many factors related to cervical anastomotic fistula after VATS in elderly patients with esophageal cancer, including history of abdominal surgery, lung infection, length of hospitalization, etc. The Logistic prediction model constructed based on high-risk factors can diagnose cervical anastomotic fistula after VATS in elderly patients with esophageal cancer. It has high predictive value and helps guide clinical treatment.

Key words： Esophageal cancer Elderly Video-assisted thoracoscopic radical resection of lung cancer Neck anastomotic fistula

基金资助:江苏省优势学科建设工程项目,(编号:YSHL1701-17)

引用本文:

赵湘, 顾园园, 滕亚莉. 老年食管癌VATS术后颈部吻合口瘘有关影响因素的Logistic回归分析与预测模型构建[J]. 河北医学, 2021, 27(12): 2065-2070.
ZHAO Xiang, GU Yuanyuan, et al. Logistic Regression Analysis and Prediction Model Construction of Related Influencing Factors of Cervical Anastomotic Leakage After VATS Operation in Elderly Patients with Esophageal Cancer. HeBei Med, 2021, 27(12): 2065-2070.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.12.029 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I12/2065

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