【摘要】 目的 分析结直肠癌术后发生肠梗阻的影响因素并构建预测模型。方法 选取2020年3月至2023年3月我院收治的300例结直肠癌患者进行回顾性分析,根据术后是否发生肠梗阻,分为观察组(发生肠梗阻,n=28)和对照组(未发生肠梗阻,n=272)。比较两组一般资料,围手术期相关指标,术前、术后当天、术后第3、第5天的C反应蛋白(CRP)、降钙素原(PCT)及白介素6 (IL6)水平。采用LASSO回归分析筛选结直肠癌术后发生肠梗阻的变量,多因素Logistic回归分析探讨结直肠癌术后发生肠梗阻的独立危险因素。绘制结直肠癌术后发生肠梗阻的列线图预测模型。绘制受试者工作特征曲线(ROC)和校准曲线,评估模型的预测能力和拟合度。结果 观察组肿瘤位置在直肠、肿瘤分期Ⅲ期、术前肠梗阻、开腹手术和中转开腹的患者比例及肿瘤直径大于对照组(P<0.05)。观察组术后当天、术后第3天、术后第5天的CRP、PCT及IL6高于对照组(P<0.05),且测量时间对术后CRP、PCT及IL6水平没有影响(P>0.05)。LASSO回归分析显示,肿瘤分期、术前肠梗阻、手术类型、术后第5天的CRP、PCT及IL6水平是结直肠癌术后发生肠梗阻的变量。多因素Logistic回归分析显示,肿瘤分期Ⅲ期、术前肠梗阻、开腹手术和中转开腹、术后第5天的CRP、PCT及IL6水平是结直肠癌术后发生肠梗阻的独立危险因素(P<0.05)。列线图预测模型的C-index为0.865,ROC曲线下面积(AUC)为0.865 (95%CI:0.799～0.902),校准曲线的C-index为0.814,模型与实际观测结果有较好的一致性。结论 肿瘤分期Ⅲ期、术前肠梗阻、开腹手术和中转开腹、术后第5天的CRP、PCT及IL6水平是结直肠癌术后发生肠梗阻的独立危险因素。基于上述因素构建的列线图模型具有良好的预测能力,可以为临床预测结直肠癌术后是否发生肠梗阻提供重要的参考依据。更多还原

【Abstract】 Objectives To analyze the influencing factors for postoperative intestinal obstruction of colorectal cancer and construct a prediction model. Methods A retrospective analysis was conducted on 300 patients with colorectal cancer admitted to our hospital from March 2020 to March 2023. They were divided into an observation group（with intestinal obstruction, n=28） and a control group（without intestinal obstruction, n=272） based on whether intestinal obstruction occurred after surgery. General information, perioperative related indicators, and levels of C-reactive protein（CRP）, procalcitonin（PCT）, and interleukin-6（IL6） before surgery, on the day of surgery, the 3^rd day and the 5^th day after surgery were compared between the two groups. LASSO regression analysis was used to screen variables for intestinal obstruction after colorectal cancer surgery, and multivariate Logistic regression analysis was used to investigate the independent risk factors for intestinal obstruction after colorectal cancer surgery. A nomogram prediction model for intestinal obstruction after colorectal cancer surgery was constructed. The receiver operating characteristic curve（ROC） and calibration curve were drawn to evaluate the prediction ability and goodness of fit of the model. Results The proportions of patients with tumor location in the rectum, tumor stage Ⅲ, preoperative intestinal obstruction, laparotomy and conversion laparotomy, as well as tumor diameter, were higher in the observation group than in the control group（P<0.05）. The levels of CRP, PCT, and IL6 on the day of surgery, the 3^rd day and the 5^th day after surgery were higher in the observation group than in the control group（P<0.05）, and the measurement time had no effect on the levels of postoperative CRP, PCT, and IL6（P>0.05）. LASSO regression analysis showed that tumor stage, preoperative intestinal obstruction, surgery type, and levels of CRP, PCT, and IL6 on the 5^th day after surgery were variables for intestinal obstruction after colorectal cancer surgery. Multivariate Logistic regression analysis showed that tumor stage Ⅲ, preoperative intestinal ob-struction, laparotomy and conversion laparotomy, and levels of CRP, PCT, and IL6 on the 5^th day after surgery were independent risk factors for intestinal obstruction after colorectal cancer surgery（P<0.05）. The C-index of the nomogram prediction model was 0.865, the area under the ROC curve（AUC） was 0.865（95%CI: 0.799-0.902）, and the C-index of the calibration curve was 0.814, indicating good consistency between the model and the actual observations. Conclusion Tumor stage Ⅲ, preoperative intestinal obstruction, laparotomy and conversion laparotomy, and levels of CRP, PCT, and IL6 on the 5^th day after surgery are independent risk factors for intestinal obstruction after colorectal cancer surgery. The nomogram model constructed based on these factors has good predictive ability and can provide an important reference for clinically predicting intestinal obstruction after colorectal cancer surgery.更多还原