摘要
目的分析决策树模型在腹腔镜直肠癌术后静脉血栓形成(VTE)风险预测中的应用价值。方法选择2022年2月至2024年2月商丘市第一人民医院收治的150例直肠癌患者作为研究对象。患者均行腹腔镜直肠癌根治术治疗,根据术后1个月内VTE发生情况分为VTE组,无VTE组。统计并比较两组患者基线资料及实验室指标。采用二元Logistic回归分析直肠癌患者腹腔镜术后VTE发生的影响因素,并构建决策树模型。采用受试者工作曲线(ROC)评估决策树模型预测直肠癌患者腹腔镜术后VTE发生的价值。结果152例直肠癌患者腹腔镜术后7 d内并发VTE 26例,发生率为17.11%(26/152);VTE组手术时间、术后制动时间长于无VTE组,术中气腹压高于无VTE组,围术期感染、VTE既往史、输血、合并糖尿病患者占比高于无VTE组(P<0.05);VTE组PLT、D-D水平高于无VTE组(P<0.05);二元Logistic回归分析结果显示,术中气腹压高、术后制动时间长、有VTE既往史、输血及血清血小板计数(PLT)、D二聚体(D-D)高表达是直肠癌患者腹腔镜术后VTE发生的危险因素(OR>1,P<0.05);由决策树可知术中气腹压、D-D水平、输血是其独立危险因素,其中术中气腹压影响最为显著;ROC结果显示,决策树模型预测直肠癌患者腹腔镜术后VTE发生的AUC0.910(95%CI:0.861~0.960),特异度0.731、灵敏度0.857、约登指数0.588。结论术中气腹压高、术后制动时间长、有VTE既往史、输血及血清PLT、D-D高表达是直肠癌患者腹腔镜术后VTE发生的影响因素,基于上述因素构建决策树模型能有效预测患者术后VTE发生风险。
ObjectiveTo analyze the application value of decision tree model in predicting the risk of venous thrombosis(VTE)after laparoscopic rectal cancer surgery.MethodsA prospective study was conducted to select 150 patients with rectal cancer admitted to the hospital from Feb.2022 to Feb.2024 as the study subjects.All patients underwent laparoscopic radical resection of rectal cancer.According to the occurrence of VTE within 1 month after operation,they were divided into VTE group and non-VTE group.The baseline data and laboratory indexes of the two groups were statistically analyzed and compared.Binary logistic regression was used to analyze the influencing factors of VTE in patients with rectal cancer after laparoscopic surgery,and a decision tree model was constructed.The receiver operating curve(ROC)was used to evaluate the value of the decision tree model in predicting the occurrence of VTE in patients with rectal cancer after laparoscopic surgery.ResultsThere were 26 cases of VTE in 152 patients with rectal cancer within 7 days after laparoscopic surgery,with an incidence of 17.11%(26/152).The operation time and postoperative immobilization time in the VTE group were longer than those in the VTE free group.The intraoperative gas abdominal pressure was higher than that in the VTE free group.The proportion of perioperative infection,past VTE history,blood transfusion,and patients with diabetes was higher than that without VTE(P<0.05).The levels of PLT and D-D in the VTE group were higher than those in the non VTE group(P<0.05).The levels of PLT and D-D in the VTE group were higher than those in the non-VTE group(OR>1,P<0.05).According to the decision tree,intraoperative pneumoperitoneum pressure,D-D level and blood transfusion were independent risk factors,among which intraoperative pneumoperitoneum pressure had the most significant effect.ROC results showed that the AUC of the decision tree model for predicting VTE after laparoscopic surgery in patients with rectal cancer was 0.910(95%CI:0.861-0.960),the specificity was 0.731,the sensitivity was 0.857,and the Youden index was 0.588.ConclusionsHigh intraoperative pneumoperitoneum pressure,long postoperative braking time,previous history of VTE,blood transfusion and high expression of PLT and D-D in serum are the influencing factors of VTE in patients with rectal cancer after laparoscopic surgery.Based on the above factors,the decision tree model can effectively predict the risk of postoperative VTE in patients.
作者
曹岩
冯亚光
丁战伟
Cao Yan;Feng Yaguang;Ding Zhanwei(Department of Gastrointestinal Surgery,Shangqiu First People’s Hospital,Shangqiu 476100,China)
出处
《中华内分泌外科杂志（中英文）》
CAS
2024年第6期881-886,共6页
Chinese Journal of Endocrine Surgery
基金
河南省医学科技功关计划项目(LHGJ20200935)。
关键词
直肠癌
静脉血栓
腹腔镜直肠癌根治术
决策树模型
Rectal cancer
Venous thrombosis
Laparoscopic radical resection of rectal cancer
Decision tree model
