摘要
目的研究不同评分系统在肝门部胆管癌手术风险评估中的应用价值。方法回顾性分析2010年3月至2013年3月本院行肝门部胆管癌手术的37例患者的临床资料。根据实际结果中的并发症发生情况,将患者分为有并发症组与无并发症组。采用计算死亡率和发病率的生理学和手术严重性评分(POSSUM)系统对并发症发生率进行预评分,统计不同区段的并发症预测发生例数,结合实际研究中各区段并发症实际发生例数,计算并发症发生率的实际/预测比(O/E)。根据所有患者的整体死亡情况将其分为死亡组和存活组,并对比两组的改良POSSUM(P-POSSUM)、急性生理功能与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、手术严重性评分(OS)及生理学评分(PS)评分。结果有并发症组患者POSSUM、OS评分均显著高于无并发症组(P<0.05),两组患者PS评分比较差异无显著性(P>0.05)。POSSUM评分系统预测并发症发生率为40.5%,实际并发症发生率为48.6%,二者比较差异无显著性(χ2=0.490,P=0.482)。死亡组患者P-POSSUM、OS评分均显著高于存活组(P<0.05),两组患者PS评分比较差异无显著性(P>0.05)。P-POSSUM评分系统预测死亡率为2.7%,实际死亡率为5.4%,二者比较差异无显著性(χ2=0.350,P=0.555)。死亡组患者APACHEⅡ、OS评分均显著高于存活组(P<0.05),两组患者PS评分比较差异无显著性(P>0.05)。APACHEⅡ评分系统预测死亡率显著高于实际死亡率(χ2=4.168,P<0.05)。结论 POSSUM评分系统能够准确预测肝门部胆管癌术后并发症发生率,P-POSSUM评分系统对术后死亡率的预测较为准确,APACHEⅡ评分系统对肝门部胆管癌手术死亡率无预测价值。
ObjectiveTo investigate the value of different scoring systems in the risk evaluation of surgical treatment of hilar cholangiocarcinoma.MethodA retrospective analysis was performed on 37 patients with hilar cholangiocarcinoma treated in our hospital from March 2010 to March 2013. According to the situation of actual complications, patients were divided into the group with complications and the one without complications. The POSSUM scoring system was performed on all patients to pre-score the incidence of complications and summarize the predicated number of patients with the complications in different sections. Afterwards, according to the actual number of patients with the complications in different sections of study, it was to calculate the practice/prediction ratio （O/E） for the incidence of complications. According to the overall situation of death, patients were divided into death group and survival group, P-POSSUM, APACHEⅡ, OS and PS scores were compared between the two groups.ResultThe POSSUM and OS scores of patients with complications were all signiifcantly higher than patients without complications （P〈0.05）. There was no signiifcant difference in PS score between the two groups （P〉0.05）. The incidence of complications predicated by POSSUM scoring system was 40.5%, while the actual incidence of complications was 48.6%, showed no signiifcant difference between the two groups （χ^2=0.490, P=0.482）. The P-POSSUM and OS scores of death group were signiifcantly higher than survival group （P〈0.05）. There was no significant difference in the PS score between the two groups （P〉0.05）. The mortality rate predicated by POSSUM scoring system was 2.7%, while the actual mortality rate was 5.4%, showed no signiifcant difference between the two groups （χ^2=0.350,P=0.555）. The APACHEⅡ and OS scores of death group were signiifcantly higher than survival group （P〈0.05）. There was no signiifcant difference in the PS score between the two groups （P〉0.05）. The mortality rate
出处
《中国医学前沿杂志（电子版）》
2015年第9期96-99,共4页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
评分系统
肝门部胆管癌
风险评估
Scoring system
Hilar cholangiocarcinoma
Risk evaluation
