个体化预测腹腔镜胃癌术后小肠梗阻的列线图模型的建立

目的探讨腹腔镜胃癌术后小肠梗阻的危险因素,并建立预测腹腔镜胃癌术后小肠梗阻的列线图模型。方法选取2017年2月-2020年12月进入淮南东方医院集团总院进行诊治的258例行腹腔镜手术的胃癌患者作为研究对象,采用Logistic回归分析筛选腹腔镜胃癌术后小肠梗阻的危险因素,采用R(R3.5.3)建立预测腹腔镜胃癌术后小肠梗阻的风险列线图模型。结果所选258例行腹腔镜手术的胃癌患者中有39例患者术后发生小肠梗阻,小肠梗阻的发生率为15.12%(39/258)。Logistic回归分析结果显示,性别(女)、年龄≥60岁、腹部手术史、BMI>24 kg/m²、糖尿病及手术医生经验≤5年是腹腔镜胃癌术后小肠梗阻的危险因素(P<0.05)。列线图模型结果显示,模型一致性指数(C-index)为0.795(95%CI:0.749~0.842)校正曲线与理想曲线基本一致,受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线下面积(AUC)为0.781,决策曲线显示阈值概率在3%~83%时,具有较高的净获益值。结论性别、年龄≥60岁、腹部手术史、BMI>24 kg/m²、糖尿病及手术医生经验≤5年是腹腔镜胃癌术后小肠梗阻的危险因素,基于危险因素建立的列线图有助于预测腹腔镜胃癌术后小肠梗阻的发生风险。

Establishment of a nomogram model for individual prediction of small bowel obstruction after laparoscopic gastric cancer surgery

Objective:To investigate the risk factors of small bowel obstruction after laparoscopic gastric cancer surgery,and establish a nomogram model for predicting small bowel obstruction after laparoscopic gastric cancer surgery.Methods 258 patients with gastric cancer who underwent laparoscopic surgery who entered our hospital from February 2017 to December 2020 were selected as the research objects.Logistic regression analysis was used to screen the risk factors of small bowel obstruction after laparoscopic gastric cancer,and R(R3.5.3)Establish a nomogram model for predicting the risk of small bowel obstruction after laparoscopic gastric cancer surgery.Results Among the selected 258 gastric cancer patients undergoing laparoscopic surgery,39 patients had small bowel obstruction after surgery,and the incidence of small bowel obstruction was 15.12%(39/258).Logistic regression analysis showed that gender(female),age≥60 years,history of abdominal surgery,BMI>24 kg/m²,diabetes and experience of surgeon≤5 years were risk factors for small bowel obstruction after laparoscopic gastric cancer surgery(P<0.05).The result of the nomogram model shows that the model consistency index(C-index)is 0.795(95%CI:0.749~0.842),the calibration curve is basically consistent with the ideal curve,and the receiver operating characteristic curve(ROC)curve The area under(AUC)is 0.781,and the decision curve shows that when the threshold probability is in the range of 3%to 83%,the net benefit value is higher.Conclusion Gender,age≥60 years,history of abdominal surgery,BMI>24 kg/m²,diabetes,and experience of surgeon≤5 years are risk factors for small bowel obstruction after laparoscopic gastric cancer surgery.A nomogram based on risk factors is helpful Predict the risk of small bowel obstruction after laparoscopic gastric cancer surgery.