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目的:评价改良POSSUM评分系统在预测腹腔镜辅助胃癌根治术患者术后并发症及死亡率方面的应用价值;方法:根据普外科及胃癌老年患者的临床特点,对传统的POSSUM评分系统相关指标进行替换,将其应用于我院胃肠肿瘤微创外科的204例腹腔镜胃癌根治术患者,对比理论预测并发症发生率与实际并发症发生率的差异,计算其预测效能。结果:全组204例患者中有67例(32.8%)患者出现了80例次术后并发症,其中局部并发症21例(10.3%),系统并发症46例(22.5%);传统POSSUM评分系统预测204例患者的并发症发生率为53.4%(109/204),预测值明显高于实际值(P<0.01),其对各亚组的并发症预测率均高于实际值(P<0.01)。改良POSSUM评分系统的预测并发症发生率为36.8%(75/204),预测值与实际值相比差异无统计学意义(P>0.05),其对各亚组并发症发生率的预测同实际值比较差异无统计学意义(P>0.05)。此外,改良POSSUM评分对并发症预测的ROC-AUC、敏感性、特异性及95%CI均优于传统POSSUM评分(P<0.05)。结论:较之于传统的POSSUM评分系统,改良的POSSUM评分系统能更准确预测腹腔镜辅助胃癌根治术的术后并发症发生率,此后的研究方向应加大样本量,探讨其进一步推广的途径。
Objective: To evaluate the value of modified POSSUM scoring system in predicting the postoperative complications and mortality of patients undergoing laparoscopic-assisted radical gastrectomy. Methods: According to the clinical features of general surgery and elderly patients with gastric cancer, the traditional POSSUM scoring system related indicators Replace it, and apply it to 204 cases of radical surgery of gastric cancer with minimally invasive gastrointestinal cancer in our hospital. Comparing the difference between the predicted rate of complication and the actual complication, the prediction efficiency is calculated. Results: Sixty-seven patients (32.8%) of 204 patients had postoperative complications including 21 cases (10.3%) of local complications and 46 cases (22.5%) of systemic complications. The traditional POSSUM score The predicted rate of complication in 204 patients was 53.4% (109/204), the predicted value was significantly higher than the actual value (P <0.01), and the predicted rate of complication in each subgroup was higher than the actual value (P < 0.01). The predictive complication rate of modified POSSUM scoring system was 36.8% (75/204). There was no significant difference between the predicted value and the actual value (P> 0.05), and the prediction of complication rate in each subgroup was the same as the actual The difference was not statistically significant (P> 0.05). In addition, the ROC-AUC predicted by the modified POSSUM score for complications was superior to the traditional POSSUM score in sensitivity, specificity and 95% CI (P <0.05). CONCLUSION: Compared with the traditional POSSUM scoring system, the improved POSSUM scoring system can predict the incidence of postoperative complications of laparoscopic-assisted radical gastrectomy more accurately. The direction of further research should be to increase the sample size and explore its further promotion .