内镜黏膜下剥离术治疗消化道早癌发生术后感染的危险因素分析

Analysis of risk factors of postoperative infection after endoscopic submucosal dissection for early gastrointestinal carcinoma

摘要:

目的 探讨内镜黏膜下剥离术（ESD）治疗消化道早癌发生术后感染的危险因素。方法 回顾性分析2018年11月－2021年11月该院83例实施ESD治疗的消化道早癌患者的临床资料，根据手术后是否发生感染分为术后未感染组（n = 60）和术后感染组（n = 23）。通过单因素分析及多因素Logistic回归分析ESD术后发生感染的危险因素，并构建ESD术后感染风险预测模型。结果 多因素Logistic回归分析显示，年龄（OR＾ = 4.644，95%CI：1.087～19.843，P = 0.035）和术中穿孔（OR＾ = 11.147，95%CI：2.136～5.168，P = 0.004）是消化道早癌患者ESD术后发生感染的危险因素。拟合优度检验：χ² = 4.95，P = 0.763（P > 0.05）；曲线下面积（AUC）为0.756（95%CI：0.636～0.875，P = 0.000），阳性预测率为62.2%，敏感度为69.6%，特异度为76.7%，临界值为0.303。结论 消化道早癌患者的年龄和手术过程中是否发生穿孔与ESD术后感染的发生紧密相关，该模型对于术后感染患者有良好的区分度和校准度，值得应用于临床。

Abstract:

Objective To investigate the risk factors of postoperative infection in patients with early gastrointestinal carcinoma treated by endoscopic submucosal dissection (ESD).Methods The clinical data of patients diagnosed early gastrointestinal carcinoma treated by ESD from November 2018 to November 2021 were reviewed for retrospective analysis. 83 patients were included, and they were divided into postoperative non-infection group (n = 60) and postoperative infection group (n = 23) according to whether infection occurred after surgery. The risk factors of infection after ESD were analyzed by univariate analysis and multivariate Logistic regression analysis, and the risk prediction model of infection after ESD was established.Results The multivariate Logistic analysis showed that age (OR＾ = 4.644, 95%CI: 1.087～19.843, P = 0.035) and intraoperative perforation (OR＾ = 11.147, 95%CI:2.136～5.168, P = 0.004) were risk factors for infection after ESD in patients with early gastrointestinal carcinoma. Goodness of fit test: χ² = 4.95, P = 0.763 (P > 0.05) and area under the curve (AUC) was 0.756 (95%CI: 0.636～0.875, P = 0.000), positive prediction rate was 62.2%, sensitivity was 69.6%, specificity was 76.7%, and the cut-off value was 0.303.Conclusion The age of patients with early gastrointestinal carcinoma and the occurrence of perforation during ESD are closely related to the occurrence of infection after ESD, and this model has good discrimination and calibration degree for patients liable to suffer postoperative infection, it is worthy of clinical application.