摘要
目的探索影响腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)过程中堵管发生的影响因素。方法根据纳入和排除标准,回顾性收集在西安交通大学第一附属医院2023年2月至2023年12月期间接受HIPEC的患者,采用单因素分析及机器学习对患者的临床特征以及与HIPEC相关的灌注记录数据进行分析。检验水准α=0.05。结果本研究共收集到符合纳入和排除标准的HIPEC患者210例,其中有51例(24.3%)发生堵管。单因素分析结果显示,灌注液入体-出体温差、灌注液流速、术前化疗、高血压病、置管方式及腹腔热灌注置管长度6个因素与HIPEC过程中堵管发生有关(P<0.05)。进一步地,将单因素分析结果和机器学习筛选的特征以及结合临床意义最终纳入了腹腔热灌注置管长度、灌注液入体-出体温差、灌注液流速、年龄、性别、术前化疗、纤维蛋白原水平、高血压病、置管方式及输血10个特征构建HIPEC过程中堵管发生的预测模型,其受试者操作特征曲线下面积(95%置信区间)为0.825(0.757,0.893)。结论本研究初步筛选出了HIPEC过程中堵管发生的影响因素,如灌注液入体-出体温差、灌注液流速、术前化疗、高血压病、置管方式、腹腔热灌注置管长度等,提示在HIPEC过程中需持续监测这些因素,从而降低堵管发生风险。
Objective To explore the risk factors affecting catheter obstruction during hyperthermic intraperitoneal chemotherapy(HIPEC).Methods Based on the inclusion and exclusion criteria,the patients who underwent HIPEC at the First Affiliated Hospital of Xi’an Jiaotong University from February 2023 to December 2023 were retrospectively collected.The data were analyzed using univariate analysis and machine learning.The statistical significance was defined asα=0.05.Results A total of 210 patients underwent HIPEC and met the inclusion criteria were included,51(24.3%)experienced catheter obstruction.The univariate analysis revealed that the inflow-outflow temperature gradient of the perfusate(ΔT of the perfusate),flow velocity of perfusate,neoadjuvant chemotherapy exposure,hypertension status,surgical approach,and HIPEC catheter length were associated with catheter obstruction(P<0.05).Subsequently,combining the results of the univariate analysis with feature values screened by machine learning,the following factors were selected,including HIPEC catheter length,ΔT of the perfusate,flow velocity of perfusate,age,gender,neoadjuvant chemotherapy exposure,fibrinogen level,hypertension status,surgical approach,and blood transfusion.A predictive model for HIPEC catheter obstruction based on these features was established,achieving an area under the receiver operating characteristic curve(95%CI)of 0.825(0.757,0.893).Conclusion This study preliminarily identifies key factors influencing the incidence of catheter obstruction during HIPEC treatment,such asΔT of the perfusate,flow velocity of perfusate,neoadjuvant chemotherapy exposure,surgical approach,HIPEC catheter length,and hypertension,continuously monitoring these factors,thereby reducing the risk of catheter obstruction.
作者
董泽鹏
王嘉浩
胡世博
Zeshaan Yahaya Haji Mahmood
余钧辉
孙学军
郑见宝
DONG Zepeng;WANG Jiahao;HU Shibo;Zeshaan Yahaya Haji Mahmood;YU Junhui;SUN Xuejun;ZHENG Jianbao(Department of General Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,P.R.China)
出处
《中国普外基础与临床杂志》
2025年第7期877-881,共5页
Chinese Journal of Bases and Clinics In General Surgery
基金
西安交通大学第一附属医院院基金项目(项目编号:2022MS-17)
西安交通大学教育基金会基金(项目编号:HX202334)。
关键词
腹腔热灌注化疗
堵管
风险因素
肿瘤
hyperthermic intraperitoneal chemotherapy
catheter obstruction
risk factors
tumor
