基于预测评分系统的高龄结直肠癌患者术后并发症的预防策略

目的探讨高龄结直肠癌患者术后并发症发生的危险因素和预防策略。方法收集2006年1月至2009年12月间北京大学人民医院胃肠外科收治并行手术治疗的107例高龄结直肠癌患者（75岁以上）的临床资料。应用POSSUM、E．POSSUM评分系统预测术后并发症发生率,并用ROC曲线及实际例数／预测例数（O／E）比值评估其效度：采用Logistic回归分析影响并发症发生的独立危险因素。结果E．POSSUM和POSSUM评分系统预测术后并发症发生率分别为13．9％。86．6％（平均32．7％）和19．1％～99．1％（平均55．5％）,E—POSSUM评分系统优于POSSUM评分系统ROC曲线下面积（AUC值）：0．862比0．576];O／E：0．771比0．454,更加接近于实际并发症发生率（25．2％,27／107）。术前合并糖尿病（P=0．019）和发病部位为直肠（P=0．005）是手术相关并发症的独立危险因素：吻合口瘘为最常见的手术相关并发症;术前合并慢性阻塞性肺病（P=0．026）、术前ASA分级（P_0．025）、术前肠梗阻（P=0．037）及术前肠穿孔（P=0．001）是非手术相关并发症的独立危险因素：肺部感染是最常见的非手术相关并发症。结论术前应用E—POSSUM评分系统可对高龄结直肠癌患者术后并发症发生率进行较为准确的预测：对于并发症发生高危患者术前应积极干预高危因素．以预防术后并发症的发生。

Prevention strategy of post-operative complications in elderly patients with colorectal cancer based on scoring systems

Objective To explore the risk factors and prevention strategies of post-operative complications in elderly patients with colorectal cancer. Methods Data of 107 elderly patients （375 years） undergoing surgery for colorectal cancer were collected from January 2006 to December 2009 in the Department of Gastrointestinal Surgery, Peking University People＇s Hospital. POSSUM and E- POSSUM scoring systems were used to predict post-operative complications. ROC curve and observe/ expect （O/E） were used to assess the validity of scoring systems. Logistic regression was used to evaluate the independent risk factors associated with post-operative complications of elderly patients with colorectal cancer. Results The predictive complication rates of E-POSSUM and POSSUM in elderly patients with colorectal cancer were 13.9%-86.6% （average, 32.7% ） and 19.1%-99.1% （average, 55.5%）. The predictive validity of E-POSSUM was better than POSSUM （AUC of ROC： 0.862 vs. 0.576, O/E： 0.771 vs. 0.454）, the former was closer to the actual complication rate（25.2%, 27/107）. Concurrent diabetes mellitus （P=0.019） and rectal lesion （P=0.005） were independent risk factors associated with surgery-related post-operative complications. Anastomotic leakage was the most common surgery-related post-operative complications. Chronic obstructive pulmonary disease （P=0.026）, ASA score （P=0.025）, intestinal obstruction （P=0.037） and perforation （P=0.001） were independent risk factors associated with non-surgery-related post-operative complications. Pulmonary infection was the most common non-surgery-related post-operative complication. Conclusions The application of E-POSSUM scoring system can provide more accurate prediction of post-operative complications in elderly patients undergoing surgery for colorectal cancer. Positive interventions should be taken for high-risk patients to prevent post-operative complications.