腹腔镜根治性胃癌切除术后淋巴漏的影响因素及列线图风险预测模型建立
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The influencing factors of lymphatic leakage after laparoscopic radical gastrectomy for gastric cancer and the establishment of nomogram risk prediction model
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    摘要:

    目的:探讨腹腔镜根治性胃癌切除术后淋巴漏发生的独立风险因素,并构建列线图预测模型。方法:回顾性分析279例行腹腔镜根治性切除术的胃癌患者的临床资料,依据患者术后是否发生淋巴漏分为淋巴漏组(n=28)和非淋巴漏组(n=251)。比较两组患者临床资料,采用Logistic回归分析确立腹腔镜根治性胃癌切除术患者术后淋巴漏发生的独立风险因素,以上述风险因素构建列线图预测模型,绘制受试者工作特征(ROC)曲线验证模型的预测价值。结果:279例患者共28例发生淋巴漏,发生率10.04%(28/279)。淋巴漏组年龄≥60岁、术前新辅助化疗、肿瘤位于贲门、T分期3~4期、联合脏器切除、扩大淋巴结清扫(D2+)及未使用生长抑素的占比均高于非淋巴漏组(P<0.05);淋巴漏组术前血红蛋白、术后血红蛋白及术后白蛋白水平均低于非淋巴漏组(P<0.05),手术时间及肛门首次排气时间均长于非淋巴漏组(P<0.05)。多因素Logistic回归分析显示:肿瘤位于贲门、T分期3~4期、联合脏器切除、扩大淋巴结清扫(D2+)、术后血红蛋白低、术后白蛋白低,及未使用生长抑素均是腹腔镜根治性胃癌切除术患者淋巴漏发生的独立风险因素(P<0.05)。列线图预测模型的ROC曲线下面积(AUC)为0.897(95%CI:0.864~0.924),敏感度和特异度分别为85.71%和80.87%。结论:肿瘤位于贲门、T分期3~4期、联合脏器切除、扩大淋巴结清扫(D2+)、术后血红蛋白低、术后白蛋白低及未使用生长抑素均与腹腔镜根治性胃癌切除术患者淋巴漏发生密切相关,基于上述因素构建的列线图预测模型可作为临床评估腹腔镜根治性胃癌切除术后淋巴漏发生的有效工具。

    Abstract:

    Objective:To explore the independent risk factors of lymphatic leakage after laparoscopic radical gastrectomy for gas-tric cancer,andto construct a nomogram prediction model for lymphatic leakage.Methods:The clinical data of 279 patients with gastric cancer who underwent laparoscopic radical resection were retrospectively analyzed.The patients were divided into lymphatic leakage group(n=28)and non-lymphatic leakage group(n=251)according to whether lymphatic leakage occurred after operation.The differences of clinical data between the two groups were compared.Logistic regression analysis was used to establish the independent risk factors of lymphatic leakage after laparoscopic radical gastrectomy for gastric cancer.The above risk factors were used to construct a nomogram prediction model for lymphatic leakage after laparoscopic radical gastrectomy for gastric cancer,and the receiver operating characteristic(ROC)curve was drawn to verify the value of the model.Results:A total of 28 cases of lymph leakage occurred in 279 patients,with an incidence of 10.04%(28/279).The proportions of age≥60,preoperative neoadjuvant chemotherapy,tumor located in the cardia,T stage 3~4,combined organ resection,extended lymph node dissection(D2+)and non-use of somatostatin in the lym-phatic leakage group were higher than those in the non-lymphatic leakage group(P<0.05).The preoperative hemoglobin,postopera-tive hemoglobin and postoperative albumin levels in the lymphatic leakage group were lower than those in the non-lymphatic leakage group(P<0.05),and the operation time and the first anal exhaust time were longer than those in the non-lymphatic leakage group(P<0.05).Multivariate Logistic regression analysis showed that tumor located in the cardia,T stage 3~4,combined organ resection,extended lymph node dissection(D2+),low postoperative hemoglobin,low postoperative albumin and no use of somatostatin were inde-pendent risk factors for lymphatic leakage in patients undergoing laparoscopic radical gastrectomy(P<0.05).The area under the ROC curve(AUC)of the nomogram prediction model was 0.897(95%CI:0.864~0.924),and the sensitivity and specificity were 85.71%and 80.87%,respectively.Conclusion:Tumor located in the cardia,T stage 3~4,combined organ resection,extended lymph node dissection(D2+),low postoperative hemoglobin,low postoperative albumin and no use of somatostatin are closely related to the occur-rence of lymphatic leakage in patients undergoing laparoscopic radical gastrectomy.The nomogram prediction model based on the above factors can be used as an effective tool for clinical evaluation of lymphatic leakage after laparoscopic radical gastrectomy.

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建立马月海;韩玉宝;.腹腔镜根治性胃癌切除术后淋巴漏的影响因素及列线图风险预测模型建立[J].川北医学院学报,2025,40(5):659-663.

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  • 在线发布日期: 2025-07-09
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