改良外科Apgar评分对肝门部胆管癌术后并发症的预测价值

刘俊鹏; 苏洋

doi:10.3969/j.issn.1001-5256.2020.04.029

改良外科Apgar评分对肝门部胆管癌术后并发症的预测价值

DOI: 10.3969/j.issn.1001-5256.2020.04.029

刘俊鹏,
苏洋

中国医科大学附属盛京医院

详细信息

中图分类号: R735.8
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出版历程
- 收稿日期: 2019-10-12
- 出版日期: 2020-04-20

Value of modified surgical Apgar score in predicting postoperative complications of hilar cholangiocarcinoma

Shengjing Hospital of China Medical University

摘要

摘要: 目的探讨改良外科Apgar评分（m SAS）对肝门部胆管癌术后并发症的预测能力。方法回顾性分析2013年4月-2019年9月于中国医科大学附属盛京医院因肝门部胆管癌手术的患者188例,分为有并发症组（n=125）和无并发症组（n=63）。比较两组患者的临床资料,包括性别、年龄、CEA、CA19-9、Bismuth-Corlett分型、术前黄疸及Alb水平、外科Apgar评分（SAS）、手术方式等。偏态分布的计量资料两组间比较采用非参数Mann-Whitney U检验。计数资料两组间比较采用χ2检验。多因素分析采用logistic回归模型,并绘制受试者工作特征曲线（ROC曲线）。ROC曲线下面积（AUC）的比较采用Z检验。结果 188例患者中125例术后出现了并发症,发生率为66. 5%。并发症组与无并发症组间m SAS差异具有统计学意义（χ2=65. 685,P <0. 001）。m SAS高分组（n=101）术后并发症发生率为40. 6%,而m SAS低分组（n=87）术后并发症发生率为96. 6%;对并发症进一步分析显示,菌血症、肺...
- 胆管肿瘤 /
- 外科Apgar评分 /
- 手术后并发症
Abstract: Objective To investigate the value of modified surgical Apgar score( m SAS) in predicting the postoperative complications of hilar cholangiocarcinoma. Methods A retrospective analysis was performed for the clinical data of 188 patients who underwent surgery due to hilar cholangiocarcinoma in Shengjing Hospital of China Medical University from April 2013 to September 2019,and the patients were divided into complication group with 125 patients and non-complication group with 63 patients. The two groups were compared in terms of related clinical data,including sex,age,carcinoembryonic antigen,carbohydrate antigen 19-9,Bismuth-Corlett type,preoperative jaundice,albumin,surgical Apgar score,and surgical approach. The nonparametric Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups,and the chi-square test was used for comparison of categorical data between two groups. A logistic regression model was used for multivariate analysis,and the receiver operating characteristic( ROC) curve was plotted. Results Of all 188 patients,125( 66. 5%) experienced complications after surgery. There was a significant difference in m SAS between the complication group and the non-complication group( χ2= 65. 685,P < 0. 001),and the patients with high m SAS had an incidence rate of postoperative complications of 40. 6%,while those with low m SAS had an incidence rate of 96. 6%. The analysis of each complication showed that there was a significant difference between the high m SAS and low m SAS patients with bacteremia,pulmonary infection,abdominal infection,incision complications,intraperitoneal hemorrhage,and liver failure( χ2= 15. 196,52. 245,48. 409,5. 556,11. 087,and 17. 772,all P <0. 05). The multivariate regression analysis showed that m SAS( odds ratio [OR]= 0. 026,95% confidence interval [CI]: 0. 007-0. 099,P < 0. 001),surgical procedure( OR = 2. 195,95% CI: 1. 070-4. 500,P = 0. 032),and severity of preoperative jaundice( OR = 2. 479,95% CI: 1. 376-4. 434,P = 0. 002) were independent influencing factors for complications after surgery for hilar cholangiocarcinoma. The m SAS had an area under the ROC curve( AUC) of 0. 830( 95% CI: 0. 768-0. 880) in predicting complications after surgery for hilar cholangiocarcinoma,while SAS had an AUC of 0. 776( 95% CI: 0. 710-0. 834). At the optimal cut-off value of 6. 5,m SAS had a sensitivity of 96. 6%,a specificity of 59. 4%,and an accuracy of 76. 6%. Conclusion The m SAS can help to predict the postoperative complications of hilar cholangiocarcinoma.
- bile duct neoplasms /
- surgical Apgar score /
- postoperative complications

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参考文献(18)

[1] RIZVI S,KHAN SA,HALLEMEIER CL,et al. Cholangiocarcinoma-evolving concepts and therapeutic strategies[J]. Nat Rev Clin Oncol,2018,15(2):95-111.

[2] WANG XY,LU L,QIN LX. Progress in clinical treatment of hilar cholangiocarcinoma[J/CD]. Chin J Hepat Surg(Electronic Edition),2018,7(4):253-257.(in Chinese)王祥宇，陆录，钦伦秀．肝门部胆管癌临床治疗进展[J/CD]．中华肝脏外科手术学电子杂志，2018,7(4):253-257.

[3] SQUADRONI M,TONDULLI L,GATTA G,et al. Cholangiocarcinoma[J]. Crit Rev Oncol Hematol,2017,116:11-31.

[4] GAWANDE AA,KWAAN MR,REGENBOGEN SE,et al. An Apgar score for surgery[J]. J Am Coll Surg,2007,204(2):201-208.

[5] MASI A,AMODEO S,HATZARAS I,et al. Use of the surgical Apgar score to enhance Veterans Affairs Surgical Quality Improvement Program surgical risk assessment in veterans undergoing major intra-abdominal surgery[J]. Am J Surg,2017,213(4):696-705.

[6] HAYASHI M,KAWAKUBO H,MAYANAGI S,et al. A low surgical Apgar score is a predictor of anastomotic leakage after transthoracic esophagectomy,but not a prognostic factor[J].Esophagus,2019,16(4):386-394.

[7] HSU SY,OU CY,HO YN,et al. Application of Surgical Apgar Score in intracranial meningioma surgery[J]. PLo S One,2017,12(4):e174328.

[8] EJAZ A,GANI F,FRANK SM,et al. Improvement of the Surgical Apgar Score by addition of intraoperative blood transfusion among patients undergoing major gastrointestinal surgery[J]. J Gastrointest Surg,2016,20(10):1752-1759.

[9] DAY KE,PRINCE AC,LIN CP,et al. Utility of the Modified Surgical Apgar Score in a head and neck cancer population[J]. Otolaryngol Head Neck Surg,2018,159(1):68-75.

[10] KOCH M,GARDEN OJ,PADBURY R,et al. Bile leakage after hepatobiliary and pancreatic surgery:A definition and grading of severity by the International Study Group of Liver Surgery[J]. Surgery,2011,149(5):680-688.

[11] RAHBARI NN,GARDEN OJ,PADBURY R,et al. Post-hepatectomy haemorrhage:A definition and grading by the International Study Group of Liver Surgery(ISGLS)[J]. HPB,2011,13(8):528-535.

[12] RAHBARI NN,GARDEN OJ,PADBURY R,et al. Posthepatectomy liver failure:A definition and grading by the International Study Group of Liver Surgery(ISGLS)[J]. Surgery,2011,149(5):713-724.

[13] ZHANG D,TAO J,SHI L,et al. Impact factors analysis of postoperative complications after radical resection for hilar cholangiocarcinoma[J/CD]. Chin J Hepat Surg(Electronic Edition),2018,7(4):280-283.(in Chinese)张东，陶杰，石磊，等．肝门部胆管癌根治术后并发症影响因素分析[J/CD]．中华肝脏外科手术学电子杂志，2018,7(4):280-283.

[14] VIRGINIA A. A proposal for a new method of evaluation of the newborn infant. Originally published in July 1953,volume 32,pages 250-259[J]. Anesth Analg,2015,120(5):1056.

[15] JANOWAK CF,BLASBERG JD,TAYLOR L,et al. The Surgical Apgar Score in esophagectomy[J]. J Thorac Cardiovasc Surg,2015,150(4):806-812.

[16] MIKI Y,TOKUNAGA M,TANIZAWA Y,et al. Perioperative risk assessment for gastrectomy by surgical apgar score[J]. Ann Surg Oncol,2014,21(8):2601-2607.

[17] JERING MZ,MAROLEN KN,SHOTWELL MS,et al. Combining the ASA physical classification system and continuous intraoperative Surgical Apgar Score measurement in predicting postoperative risk[J]. J Med Syst,2015,39(11):147.

[18] CHEN H,ZHOU Y,LIU ZB,et al. A retrospective study of risk factors on serious postoperative complication in hilar cholangiocarcinoma[J]. Chin J Surg Integr Tradit West Med,2016,22(1):6-10.(in Chinese)陈浩，周洋，刘占兵，等．肝门部胆管癌术后严重并发症的回顾性分析[J]．中国中西医结合外科杂志，2016,22(1):6-10.

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