肝癌根治性切除术后延迟性肠麻痹发生预测模型的构建与验证*

doi:10.3969/j.issn.1672-5069.2025.01.034

实用肝脏病杂志 ›› 2025, Vol. 28 ›› Issue (1): 132-135.doi: 10.3969/j.issn.1672-5069.2025.01.034

肝癌根治性切除术后延迟性肠麻痹发生预测模型的构建与验证^*

申磊, 胡晓露, 张青和

221000 江苏省徐州市徐州医科大学附属医院麻醉科(申磊, 胡晓露);徐州市中医院麻醉科(张青和)

收稿日期:2024-04-15 出版日期:2025-01-10 发布日期:2025-02-07
通讯作者: 张青和,E-mail:zqh13952236029@163.com
作者简介:申磊,男,33岁,硕士研究生,主治医师。研究方向:重要脏器功能保护。E-mail:15262005563@163.com
基金资助:
^*江苏省自然科学基金基础研究计划面上项目(编号:BK20201183)

Construction and validation of prediction model fordelayed postoperative intestinal paralysis in patients with primary liver cancer after radical hepatectomy

Shen Lei, Hu Xiaolu, Zhang Qinghe

Department of Anesthesiology, Affiliated Hospital, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China

Received:2024-04-15 Online:2025-01-10 Published:2025-02-07

摘要/Abstract

摘要： 目的分析根治性切除术治疗原发性肝癌(PLC)患者术后延迟性肠麻痹(DPOI)发生的影响因素,并据此构建预测模型和验证。方法 2022年1月～2023年10月我科收治的PLC患者135例,51例接受开腹,84例接受腹腔镜根治性肝癌切除术治疗。计算系统免疫炎症指数(SII),常规检测血清C反应蛋白(CRP)和白蛋白水平,计算CRP/白蛋白比值(CAR)。应用二元Logistic回归分析影响DPOI发生的因素,构建Nomogram列线图,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估列线图模型的预测效能。结果在本组135例PLC患者中,肝癌切除术后发生DPOI者38例(28.2%);单因素分析显示,年龄、中国PLC分期方案(CNLC)分期、手术方式、应用阿片类药物、SII水平和CAR均显著影响DPOI的发生(P＜0.05);多因素逐步Logistic回归分析显示,CNLC分期(OR=5.273,95%CI:2.195～12.663)、手术方式(OR=3.046,95%CI:1.721～5.388)、应用阿片类药物(OR=4.457,95%CI:2.166～9.168)和CAR水平(OR=5.856,95%CI:3.177～10.793)均是术后发生DPOI的独立危险因素(P＜0.05);经ROC曲线分析,基于上述影响因素构建的列线图预测术后DPOI发生的AUC为0.894(95%CI:0.813～0.974,P＜0.05),其敏感度为89.5%,特异性为90.7%。结论根治性肝癌切除术后患者可能发生DPOI,熟悉其发生的危险因素可以做到早期干预和预防,对提高术后康复有帮助。

关键词: 原发性肝癌, 根治性切除术, 延迟性肠麻痹, 列线图, 预测

Abstract: Objective This study was conducted to analyze influencing factors of delayed postoperative intestinal paralysis (DPOI) in patients with primary liver cancer (PLC) after radical hepatectomy and to construct and validate a nomogram prediction model based on risk factors for prediction. Method A total of 135 patients with PLC were encountered in our hospital between January 2022 and October 2023, and 51 patients received open surgery and 84 patients received laparoscopic hepatectomy. Systemic immune inflammation index (SII), and C-reactive protein/albumin ratio (CAR) were calculated. Univariate and multivariate Logistic regression analysis were applied to reveal risk factors, and receiver operating characteristic (ROC) curve was drawn for prediction efficacy. Result Of 135 patients with PLC in our series, DPOI occurred in 38 cases (28.2%) after hepatectomy; univariate Logistic regression analysis showed that ages, China liver cancer staging scheme (CNLC), operation, opioid use, SII and CAR were all related to DPOI happening (P＜0.05), and multivariate Logistic regression analysis demonstrated that CNLC(OR=5.273, 95%CI:2.195-12.663), operation (OR=3.046, 95%CI:1.721-5.388), opioid use (OR=4.457, 95%CI:2.166-9.168) and CAR (OR=5.856, 95%CI: 3.177-10.793) were all the independent risk factors for DPOI occurrence (P＜0.05); ROC analysis showed the AUC was 0.894(95%CI: 0.813-0.974, P＜0.05), with sensitivity of 89.5% and specificity of 90.7%, when the nomogram prediction model based on risk factors was applied for predicting DPOI occurrence. Conclusion Postoperative DPOI could occur in patients with PLC after radical resection of liver cancer, and early warning and intervention might improve the recovery.

Key words: Hepatoma, Radical hepatectomy, Delayed postoperative intestinal paralysis, Nomogram, Prediction

申磊, 胡晓露, 张青和. 肝癌根治性切除术后延迟性肠麻痹发生预测模型的构建与验证^*[J]. 实用肝脏病杂志, 2025, 28(1): 132-135.

Shen Lei, Hu Xiaolu, Zhang Qinghe. Construction and validation of prediction model fordelayed postoperative intestinal paralysis in patients with primary liver cancer after radical hepatectomy[J]. Journal of Practical Hepatology, 2025, 28(1): 132-135.

参考文献

[1] Cheng K, Cai N, Zhu J, et al. Tumor-associated macrophages in liver cancer: From mechanisms to therapy J. Cancer Commun (Lond), 2022,42(11):1112-1140.
[2] Chowdhury MMH, Salazar CJJ, Nurunnabi M. Recent advances in bionanomaterials for liver cancer diagnosis and treatment J. Biomater Sci, 2021,9(14):4821-4842.
[3] Ronot M, Nahon P, Rimola J. Screening of liver cancer with abbreviated MRI J. Hepatology, 2023,78(2):670-686.
[4] Sposito C, Ratti F, Cucchetti A, et al. Survival benefit of adequate lymphadenectomy in patients undergoing liver resection for clinically node-negative intrahepatic cholangiocarcinoma J. J Hepatol, 2023,78(2):356-363.
[5] Fan ZQ, Chen Y, Fu XA, et al. Nomogram for predicting prolonged postoperative ileus in colorectal cancer based on age and inflammatory markers J. Biomark Med, 2023,17(22):921-933.
[6] de Gaay Fortman DPE, Kroon HM, Bedrikovetski S, et al. A snapshot of intraoperative conditions to predict prolonged postoperative ileus after colorectal surgery J. ANZ J Surg, 2022,92(9):2199-2206.
[7] 张景辉,金岚,李俊,等. 开腹腹部手术延迟性术后肠麻痹的危险因素分析. 首都医科大学学报,2020,41(4):636-640.
[8] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版). 中华肝脏病杂志,2020,28(2):112-128.
[9] Kok B, Abraldes JG. Child-Pughclassification: Time to abandon? Semin Liver Dis, 2019,39(1):96-103.
[10] Gervais HW. The ASAclassification-solid like a rock in anesthesiology J. Anaesthesist, 2017,66(1):3-4.
[11] Vather R, Trivedi S, Bissett I. Defining postoperative ileus: results of a systematic review and global survey J. J Gastrointest Surg, 2013,17(5):962-972.
[12] Seo SHB, Carson DA, Bhat S, et al. Prolonged postoperative ileus following right- versus left-sided colectomy: A systematic review and meta-analysis. Colorectal Dis, 2021,23(12):3113-3122.
[13] Pozios I, Seeliger H, Lauscher JC, et al. Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn's disease J. Int J Colorectal Dis, 2021,36(10):2165-2175.
[14] Quiroga-Centeno AC, Jerez-Torra KA, Martin-Mojica PA, et al. Risk factors for prolonged postoperative ileus in colorectal surgery: A systematic review and meta-analysis J. World J Surg, 2020,44(5):1612-1626.
[15] Xie D, Shi J, Zhou J, et al. Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Chinese perspective. Clin Mol Hepatol, 2023,29(2):206-216.
[16] Liang WQ, Zhang KC, Li H, et al. Preoperative albumin levels predict prolonged postoperative ileus in gastrointestinal surgery J. World J Gastroenterol, 2020,26(11):1185-1196.
[17] 田震,张凯凯,李云龙,等. 结直肠癌根治性切除术后延迟性肠麻痹的危险因素分析. 中华普通外科杂志,2024,39(1):36-40.
[18] Sammut R, Trapani J, Deguara J, et al. The effect of gum chewing on postoperative ileus in open colorectal surgery patients: A review. J Perioper Pract, 2021,31(4):132-139.
[19] Xu W, Vather R, Bissett IP, et al. Effect of opiate use on prolonged postoperative ileus: a prospective cohort study J. J Gastrointest Surg, 2020,24(8):1866-1868.
[20] Kim Y, Kim YM, Kim JH, et al. Peri-operative inflammatory marker as a predictive factor for prolonged post-operative ileus after gastrectomy for gastric cancer J. J Neurogastroenterol Motil, 2021,27(4):588-595.
[21] 方亮,李欣,肖丹,等. 新型炎症评分系统与胃癌延迟性术后肠麻痹的关系及预测模型构建. 中国现代医学杂志,2023,33(19):30-38.

肝癌根治性切除术后延迟性肠麻痹发生预测模型的构建与验证^*

Construction and validation of prediction model fordelayed postoperative intestinal paralysis in patients with primary liver cancer after radical hepatectomy

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