两种评分预测结直肠癌患者术后并发症风险的研究

目的探讨外科Apgar评分和结直肠-生理和手术危险度评分预测结直肠癌患者术后并发症风险的价值。 方法回顾性分析2017年9月~2018年9月间中国医学科学院肿瘤医院重症医学科（ICU）收治的接受结直肠癌手术的患者资料。全组177例。回顾计算每例患者的外科Apgar评分（SAS）和结直肠-生理和手术危险度评分（CR-POSSUM）。根据患者术后是否发生并发症分为无并发症组和有并发症组。根据患者术后并发症的发生情况分为严重并发症组和无或轻微并发症组。严重并发症定义为Clavien-Dindo分级III级以上的并发症。 结果单因素分析发现：术中SAS评分和CR-POSSUM评分均不能预测术后严重并发症的发生。单因素分析还发现：仅术中SAS评分可预测术后并发症的发生（χ²=6.127，P=0.013），而CR-POSSUM评分不能预测术后并发症发生。受试者工作曲线分析发现术中SAS评分预测患者结直肠癌术后发生并发症的AUROC为0.605±0.043［（95%可信区间：0.521~0.689），P=0.017］。取截尾值为9时，术中SAS评分预测患者结直肠术后发生严重并发症的敏感性58.8%和特异性60.0%。 结论术中SAS评分与结直肠癌患者术后并发症的发生相关，但是预测能力中等，需要配合其他工具共同使用。

Performance of two prediction scores in predicting postoperative morbidities after colorectal surgery

Objective To investigate the value of two prediction scores in predicting postoperative morbidities after colorectal surgery.Methods Data of patients who underwent colorectal surgery between September 2017 and September 2018 were retrospectively collected and reviewed.There were 177 patients in total.Surgical Apgar Score(SAS)and colorectal physiological and operative severity score for the enumeration of mortality and morbidity(CR-POSSUM)were calculated for each patient.Patients were grouped as morbidity group and normal group.And patients were grouped as major complication group and no or minor complication group.Major complication was defined as complications grade 3 and upper according to the definition of Clavien-Dindo grading.Results Univariable analysis demonstrated that neither SAS nor CR-POSSUM was predictive of the occurrence of major complication.And Univariable analysis demonstrated that only SAS was predictive of the occurrence of postoperative complication(χ^2=6.127,P=0.013),while CR-POSSUM was not.Receiver operation curve(ROC)demonstrated that area under the curve of intraoperative SAS in predicting the occurrence of complication after colorectal surgery was 0.605±0.043(95%CI:0.521~0.689,P=0.017).Sensitivity and specificity of SAS was 58.8%and 60.0%respectively in predicting the occurrence of complication when the cutoff was set as 9.Conclusion Intraoperative Surgical Apgar Score was predictive of the occurrence of complication after colorectal surgery with moderate discrimination.It should be in combination with other prediction tools.