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微创泌尿外科杂志  2020, Vol. 9 Issue (2): 125-129    DOI: 10.19558/j.cnki.10-1020/r.2020.02.012
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美国外科风险计算器预测老年前列腺癌患者手术风险的价值
卢文宁1, 高龄根1, 刘朝阳1, 高德伟1
1 中国人民解放军总医院第二医学中心综合外科 100853 北京
The predictive value of American College of Surgeon's surgical risk calculator for disposition in older patients with prostate carcinoma undergoing robot-assisted laparoscopic radical prostatectomy in PLA General Hospital of China
LU Wenning1, GAO Linggen1, LIU Chaoyang1, GAO Dewei1
1 Department of Comprehensive Surgery, the Second Medical Center, Chinese PLA Genaral Hospital,Beijing 100853, China
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摘要 目的:评估基于美国临床大数据的手术风险计算器能否良好预估老年前列腺癌患者的手术风险。方法:收集2016年1月–2018年12月在中国人民解放军总医院接受机器人辅助腹腔镜前列腺癌根治术的65岁以上老年患者临床资料,使用美国外科风险计算器计算术后并发症发生率并与实际发生率比较。采用logistic回归分析与ROC曲线进行统计分析。结果:本研究共收集693例,比较结果显示:美国外科风险计算器能良好预测接受机器人辅助腹腔镜前列腺癌根治术的65岁以上老年患者的术后严重并发症(c-statistic=0.864)、总体并发症(c-statistic=0.827)、肺炎(c-statistic=0.882)、心脏并发症(c-statistic=0.885)、泌尿系感染(c-statistic=0.875)、深静脉血栓(c-statistic=0.809)、急性肾衰(c-statistic=0.940)、切口感染(c-statistic=0.818)和二次手术(c-statistic=0.798),计算器预估发生率与实际发生率近似;但是在死亡发生率(c-statistic=0.445)方面存在较大差异;平均住院日存在显著差异,预测为(1.21±1.54)d,实际为(14.64±7.03)d(P=0.00)。结论:美国外科风险计算器能良好预测机器人辅助腹腔镜前列腺癌根治术老年患者术后常见和严重并发症;国内同级别医院外科医生可以参考美国外科风险计算器预测的手术风险决策手术方案。
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卢文宁
高龄根
刘朝阳
高德伟
关键词 前列腺癌机器人手术老年外科风险计算    
AbstractObjectives: To evaluate the value of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator (SRC) to predict complications in elderly patients with prostate carcinomas undergoing elective robot-assisted laparoscopic radical prostatectomy (RALRP) in PLA General Hospital of China.corresponding author: Methods: A chart review of patients aged ≥65 years who underwent RALRP on prostate carcinomas service at a single academic hospital from January 2016 to December 2018 was performed. Preoperative variables were collected and NSQIP surgical risk scores were calculated. The risk of any complication, serious complications, death, urinary tract infection (UTI), venous thromboembolism (VTE), cardiac event, renal complication, pneumonia and surgical site infection (SSI) were analyzed and compared with the actual patient outcomes. The logistic and c-statistic were used to evaluate the predictive value of the risk calculator. Results: This study included 693 consecutive patients. The ACSNSQIP calculator performed well for serious complications (c-statistic=0.864), any complications (c-statistic=0.827), pneumonia complications (c-statistic=0.882), cardiac complications (c-statistic=0.885), UTI (c-statistic=0.875), VTE (c-statistic=0.809), renal failure (c-statistic=0.940), SSI (c-statistic=0.818) and return operation room (c-statistic=0.798). The calculator performed the worst for predicting death (c-statistic=0.445). Conclusions: The NSQIP surgical risk calculator accurately predicts any and most complications in PLA General Hospital of China. Surgeons in hospitals of the same level in China can consult the surgical risks predicted by ACS NSQIP surgical calculators to make decisions with patients and their families.
Key wordsprostatectomy    robot-assisted    elderly    surgical risk calculator
收稿日期: 2019-06-10     
ZTFLH:  R737.25  
通讯作者: 高德伟, Gaodw301@sina.com   
引用本文:   
卢文宁, 高龄根, 刘朝阳, 高德伟. 美国外科风险计算器预测老年前列腺癌患者手术风险的价值[J]. 微创泌尿外科杂志, 2020, 9(2): 125-129.
LU Wenning, GAO Linggen, LIU Chaoyang, GAO Dewei. The predictive value of American College of Surgeon's surgical risk calculator for disposition in older patients with prostate carcinoma undergoing robot-assisted laparoscopic radical prostatectomy in PLA General Hospital of China. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(2): 125-129.
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