摘要
目的探讨改良外科Apgar评分(mSAS)对肝门部胆管癌术后并发症的预测能力。方法回顾性分析2013年4月-2019年9月于中国医科大学附属盛京医院因肝门部胆管癌手术的患者188例,分为有并发症组(n=125)和无并发症组(n=63)。比较两组患者的临床资料,包括性别、年龄、CEA、CA19-9、Bismuth-Corlett分型、术前黄疸及Alb水平、外科Apgar评分(SAS)、手术方式等。偏态分布的计量资料两组间比较采用非参数Mann-Whitney U检验。计数资料两组间比较采用χ2检验。多因素分析采用logistic回归模型,并绘制受试者工作特征曲线(ROC曲线)。ROC曲线下面积(AUC)的比较采用Z检验。结果188例患者中125例术后出现了并发症,发生率为66.5%。并发症组与无并发症组间mSAS差异具有统计学意义(χ2=65.685,P<0.001)。mSAS高分组(n=101)术后并发症发生率为40.6%,而mSAS低分组(n=87)术后并发症发生率为96.6%;对并发症进一步分析显示,菌血症、肺部感染、腹腔感染、切口并发症、腹腔出血以及肝衰竭在两组间差异有统计学意义(χ2值分别为15.196、52.245、48.409、5.556、11.087、17.772,P值均<0.05)。多因素回归分析显示,mSAS[优势比(OR)=0.026,95%可信区间(95%CI:0.007~0.099,P<0.001)、手术方式(OR=2.195,95%CI:1.070~4.500,P=0.032)、术前黄疸水平(OR=2.470,95%CI:1.376~4.434,P=0.002)]是影响肝门部胆管癌术后并发症发生的独立因素。mSAS与SAS预测肝门部胆管癌术后出现并发症的AUC分别为0.830(95%CI:0.768~0.880)和0.776(95%CI:0.710~0.834)。mSAS的最佳临界值为6.5,敏感度为96.6%,特异度为59.4%,准确度为76.6%。结论mSAS有助于预测肝门部胆管癌术后并发症的发生。
Objective To investigate the value of modified surgical Apgar score(mSAS)in predicting the postoperative complications of hilar cholangiocarcinoma.Methods A retrospective analysis was performed for the clinical data of 188 patients who underwent surgery due to hilar cholangiocarcinoma in Shengjing Hospital of China Medical University from April 2013 to September 2019,and the patients were divided into complication group with 125 patients and non-complication group with 63 patients.The two groups were compared in terms of related clinical data,including sex,age,carcinoembryonic antigen,carbohydrate antigen 19-9,Bismuth-Corlett type,preoperative jaundice,albumin,surgical Apgar score,and surgical approach.The nonparametric Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups,and the chi-square test was used for comparison of categorical data between two groups.A logistic regression model was used for multivariate analysis,and the receiver operating characteristic(ROC)curve was plotted.Results Of all 188 patients,125(66.5%)experienced complications after surgery.There was a significant difference in mSAS between the complication group and the non-complication group(χ2=65.685,P<0.001),and the patients with high mSAS had an incidence rate of postoperative complications of 40.6%,while those with low mSAS had an incidence rate of 96.6%.The analysis of each complication showed that there was a significant difference between the high mSAS and low mSAS patients with bacteremia,pulmonary infection,abdominal infection,incision complications,intraperitoneal hemorrhage,and liver failure(χ2=15.196,52.245,48.409,5.556,11.087,and 17.772,all P<0.05).The multivariate regression analysis showed that mSAS(odds ratio[OR]=0.026,95%confidence interval[CI]:0.007-0.099,P<0.001),surgical procedure(OR=2.195,95%CI:1.070-4.500,P=0.032),and severity of preoperative jaundice(OR=2.479,95%CI:1.376-4.434,P=0.002)were independent influencing factors for complications after surgery for hilar cho
作者
刘俊鹏
苏洋
LIU Junpeng;SU Yang(Shengjing Hospital of China Medical University, Shenyang 110004, China)
出处
《临床肝胆病杂志》
CAS
北大核心
2020年第4期855-859,共5页
Journal of Clinical Hepatology
