腹腔镜直肠癌根治术病人术后胃肠功能影响因素分析

doi:10.3969/j.issn.1005-6483.20241237

摘要/Abstract

摘要： 目的探讨腹腔镜直肠癌根治术（LRR）病人术后胃肠功能影响因素，以此构建预测模型。方法 2021年2月～2024年4月行LRR病人155例，依据术后进食-恶心-呕吐-体格检查-症状持续时间评分系统（I-FEED）评估结果分为术后胃肠功能障碍（POGD）组和非POGD组。收集病人临床资料，采用Logistic回归分析LRR病人发生POGD的影响因素，构建LRR病人POGD的预测模型，受试者工作特征（ROC）曲线评价该模型的预测效能，H-L检验该模型的校准能力。结果 LRR病人155例，剔除术中中转开腹2例、资料不全1例，共纳入152例。152例LRR病人POGD发生率为33.55%（51/152）。Logistic回归分析发现，年龄（OR=2.687，95%CI=1.422～5.078，P＝0.003），吸烟史（OR=2.564，95%CI=1.395～4.713，P＝0.004），术前白蛋白（Alb）水平（OR=0.851，95%CI=0.781～0.927，P＜0.001），右美托咪定复合全身麻醉（OR=0.382，95%CI=0.214～0.682，P＝0.001），腹部辅助性切口位置（OR=2.992，95%CI=1.278～7.006，P＝0.007），肠系膜下动脉结扎位置（OR=3.784，95%CI=1.624～8.815，P＝0.001）是LRR病人发生POGD的独立影响因素。ROC曲线显示，应用上述影响因素构建的预测模型预测LRR病人发生POGD的曲线下面积（AUC）为0.905，预测效能良好。H-L拟合优度检验显示，该预测模型预测值与实测值比较，差异无统计学意义（P＞0.05），具有良好的校准能力。结论年龄、吸烟史、术前Alb水平、右美托咪定复合全身麻醉、腹部辅助性切口位置、肠系膜下动脉结扎位置均可影响LRR病人POGD的发生，据此构建的预测模型具有良好的预测价值与校准能力，临床可据此予以针对性防治以降低POGD发生风险。

关键词: 腹腔镜直肠癌根治术, 术后胃肠功能障碍, 影响因素, 预测模型

Abstract: Objective To investigate the predictive factors for postoperative gastrointestinal function in patients undergoing laparoscopic radical rectectomy (LRR), and thereby construct a predictive model.Methods A total of 155 patients who underwent LRR at our hospital from February 2021 to April 2024 were selected for this study.Based on the postoperative intake-nausea-vomiting-examination-duration of symptoms (I-FEED) scoring system,patients were divided into postoperative gastrointestinal dysfunction (POGD) and non-POGD groups.Clinical data of the selected patients were collected,and Logistic regression analysis was used to identify factors influencing the occurrence of POGD in LRR patients.A predictive model for POGD was constructed,and its predictive performance was evaluated using the receiver operating characteristic (ROC) curve.The calibration ability of the model was assessed using the H-L test.Results Of the 155 LRR patients,2 were excluded due to intraoperative conversion to open surgery and 1 due to insufficient data,resulting in a total of 152 patients included in the analysis.The incidence of POGD in these 152 patients was 33.55% (51/152).Logistic regression analysis identified age (OR=2.687,95%CI=1.422-5.078,P=0.003),smoking history (OR=2.564,95%CI=1.395-4.713,P=0.004),preoperative albumin (Alb) level (OR=0.851,95%CI=0.781-0.927,P＜0.001),dexmedetomidine combined with general anesthesia (OR=0.382,95%CI=0.214-0.682,P=0.001), the location of the abdominal auxiliary incision (OR=2.992,95%CI=1.278-7.006,P=0.007) and ligation location of inferior mesenteric artery (OR=3.784,95%CI=1.624-8.815,P=0.001) as influencing factors for POGD in LRR patients.The ROC curve showed that the predictive model constructed using these factors had an area under the curve (AUC) of 0.905,indicating good predictive performance.The H-L goodness-of-fit test showed no significant difference between the predicted and observed values (P>0.05),indicating good calibration ability.Conclusion Age,smoking history,preoperative Alb level,dexmedetomidine combined with general anesthesia,the location of the abdominal auxiliary incision and ligation location of inferior mesenteric artery are influencing factors for POGD in LRR patients.The predictive model constructed based on these factors has good predictive value and calibration ability,providing a basis for targeted prevention and treatment to reduce the risk of POGD.

Key words: laparoscopic radical rectectomy, postoperative gastrointestinal dysfunction, Iinfluencing factors, predictive model

李翔周林秋李珺佘晶江许剑段建春李玉文. 腹腔镜直肠癌根治术病人术后胃肠功能影响因素分析[J]. 临床外科杂志, 2025, 33(7): 730-.

LI Xiang, ZHOU Linqiu, LI Jun, SHE Jingjiang, XU Jian, DUAN Jianchun, LI Yuwen. Exploration of the influencing factors on gastrointestinal function in patients undergoing laparoscopic radical resection of rectal cancer after surgery[J]. JOURNAL OF CLINICAL SURGERY, 2025, 33(7): 730-.

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