摘要
目的构建消化道早癌患者应用内镜黏膜下剥离术(ESD)治疗后术后出血的预测模型。方法回顾性分析2013年5月-2020年3月新疆医科大学第二附属医院内镜中心治疗的560例消化道早癌患者临床资料,并依据ESD术后是否出血分为出血组(n=25)、对照组(n=535)。采用logistic回归分析ESD术后出血的危险因素,根据筛选的危险因素构建ESD术后出血风险预测模型,并采用ROC曲线对预测模型进行评价。结果多因素logistic回归分析显示,有高血压(OR=3.59,95%CI:1.72~6.86,P=0.000)、操作时间>90 min(OR=1.67,95%CI:1.18~3.73,P=0.008)、最大病灶直径≥3 cm(OR=1.55,95%CI:1.23~3.12,P=0.002)、病灶位于直肠(OR=1.71,95%CI:1.26~3.98,P=0.012)为消化道早癌患者ESD术后出血的危险因素。ROC曲线分析显示,模型预测消化道早癌患者ESD术后出血的AUC为0.865(95%CI:0.849~0.976,P=0.000),准确率82.32%、敏感度84.00%、特异度82.24%、临界值为0.545。结论消化道早癌患者ESD术后出血与高血压、操作时间、病灶直径及病灶部位有关,预测模型可有效预测个体ESD术后出血风险。
Objective The present study aims to construct a predictive model for postoperative bleeding in patients with early gastrointestinal cancer after treatment with endoscopic submucosal dissection(ESD).Methods A retrospective analysis was used to analyze the clinical data of 560 patients with early gastrointestinal cancer from May 2013 to March 2020.According to whether hemorrhage after ESD,the patients were divided into postoperative bleeding group 25 cases and control group 535 cases.Multivariate logistic regression was used to identify the risk factors of postoperative bleeding after ESD.ROC curve was used to evaluate the predictive model.Results Multivariate logistic regression analysis showed that hypertension(OR=3.59,95%CI:1.72-6.86,P=0.000),operation time>90 min(OR=1.67,95%CI:1.18-3.73,P=0.008),the largest lesion diameter≥3 cm(OR=1.55,95%CI:1.23-3.12,P=0.002),the lesion located in the rectum(OR=1.71,95%CI:1.26-3.98,P=0.012)were the risk factors of postoperative bleeding in patients with early gastrointestinal cancer after ESD.ROC curve analysis showed that the AUC of predicting for postoperative bleeding in patients with early gastrointestinal cancer after ESD was 0.865(95%CI:0.849-0.976,P=0.000),the accuracy rate was 82.32%,sensitivity was 84.00%,and specificity was 82.24%with the cut-off value was 0.545.Conclusion Hemorrhage after ESD in patients with early gastrointestinal cancer/precancerous lesions are related to hypertension,operation time,lesion diameter,and lesion location.The prediction model can effectively predict the risk of individual bleeding after ESD.
作者
吴江
吴涛
庞澜
阿里木江·阿不都热合曼
马秀英
陈鹏
朱勇荷
WU Jiang;WU Tao;PANG Lan;ALIMUJIANG·Abdul Rahman;MA Xiu-ying;CHEN Peng;ZHU Yong-he(Department of Endoscopy,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830063,Xinjiang,China;Department of Oncology,Chinese Medicine Hospital Affiliated to Xinjiang Medical University,Urumqi 830000,Xinjiang,China)
出处
《医学研究生学报》
CAS
北大核心
2021年第2期155-160,共6页
Journal of Medical Postgraduates
基金
新疆维吾尔自治区自然科学基金(2016D01C201)。
关键词
消化道早癌
内镜黏膜下剥离术
术后出血
预测模型
early gastrointestinal cancer
endoscopic submucosal dissection
postoperative bleeding
predictive model
