改良POSSUM 评分系统预测老年胃癌患者术后并发症发生率价值.docVIP

改良POSSUM 评分系统预测老年胃癌患者术后并发症发生率价值 　　【摘要】 目的 应用改良POSSUM评分系统对预测老年胃癌患者术后并发症发生率的作用。方法 根据老年胃癌患者特点,改良POSSUM 评分系统中脉率、手术种类、手术范围及恶性肿瘤等四项进行替换,预测117例老年胃癌患者术后并发症的发生率,比较并发症的实际发生率与理论预测率。结果 117例患者实际并发症发生率为29.91% (35例),理论预测发生率为 19.65%(23例),并发症的实际发生率和理论预测率比较差异无统计学意义(χ?2=3.301,P=0.069)。实际并发症组与无并发症组的生理学评分和手术侵袭度评分比较差异有统计学意义(P0.05)。结论 改良POSSUM评分系统可较好地预测老年患者胃癌术后并发症的发生率。 　　【关键词】 老年胃癌;改良POSSUM评分系统;并发症 　　 　　Estimation modified P0SSUM in predicting postoperative morbidity in elderly patients after gastrectomy 　　TU Yun-zhong,ZHANG Jian,LIU Hui-ping. 　　General Surgery in 12th People’s Hospital of Guangzhou, Guangdong 510620, China 　　 　　【Abstract】 Objective To investigate the clinical value of modified POSSUM surgical scoring system in evaluating the morbidity of elderly patients after gastrectomy.Methods Replaced some indexs of POSSUM, such as pulse rate, type of surgery,surgical scope and degree of m alignant And then used the modified P0SSUM system to forecast the complication of 117 elderly patients after gastrectomy. Results the actual complicationrate were 29.91% (35 cases),the forecast morbidity rate were 19.65%(23 cases),compared with the two groups,morbidity showed no Statistical significance(χ?2=3.301,P=0.069),while the score of actual complication case compared with the no complication showed statistical significance (P0.05).Conclusion The modified POSSUM surgical scoring system can evaluate and predict the prognosis of the elderly patients after gastrectomy. 　　【Key words】 Elderly patients of gastric cancer; Modified POSSUM surgical scoring system; Complication 　　 　　有报道[1]基于生理和手术严重度对患者预后影响的POSSUM评分系统是一种判断手术死亡率和并发症发生率的评分方法,对普通外科、血管外科、胸科大手术的风险有较好的评估意义。为此,笔者根据老年胃癌患者的一些特点,对POSSUM评分系统进行了改良,并应用其对老年胃癌患者术后并发症预测,与实际术后并发症发生率相比较,以判断改良POSSUM评分的临床应用价值。 　　1 资料与方法 　　1.1 一般资料 收集我院2000年10月至2008年10月间手术治疗的老年胃癌患者117例,男72例,女45例,平均年龄(66.87±5.27)岁(60~86岁)。入院后完善12项生理相关指标检查,术前均行胃镜及上腹部低张CT检查明确诊断,其中腺癌53例,粘液癌29例,低分化癌21例,印戒细胞癌11例,重度上皮不典型增生3例。手术方式:D1 18例,D2 94例,D2+脾切除3例,胃空肠吻合2例;因出血行急诊手术2例。手术为同一组手术人员完成