POSSUM和P-POSSUM评分系统预测LPD手术风险的价值研究
Predictive Value of POSSUM and P-POSSUM Scoring System for Risk Assessment in Laparoscopic Pancreatoduodenectomy
作者：蔡合, 王昕, 蔡云强, 李永彬, 孟令威, 彭兵
Author：CAI He, WANG Xin, CAI Yun-qiang, LI Yong-bin, MENG Ling-wei, PENG Bing
收稿日期：2018-09-17 年卷（期）页码：2019,50(3):429-432
期刊名称：四川大学学报（医学版）
Journal Name：JOURNAL OF SICHUAN UNIVERSITY （MEDICAL SCIENCE EDITION）
关键字：POSSUM评分系统, P-POSSUM评分系统, 腹腔镜胰十二指肠切除术, 并发症, 死亡
Key words：POSSUM scoring system, P-POSSUM scoring system, Laparoscopic pancreatoduodenectomy, Complications rate, Mortality
基金项目：
中文摘要
目的 探讨POSSUM和P-POSSUM评分系统在预测腹腔镜胰十二指肠切除术（LPD）并发症发生率及病死率中的价值。 方法 回顾性分析2014年2月至2017年7月四川大学华西医院收治的132例接受LPD患者的临床资料, 收集所有患者的12项术前生理评分及6项手术评分, 以受试者工作特征（ROC）曲线评估POSSUM评分系统预测LPD术后并发症的价值, 并分层分析POSSUM评分系统预测的能力。分别评估POSSUM、P-POSSUM评分系统预测病死率和真实水平的差异。 结果 以POSSUM评分系统预测LPD术后并发症的有无，ROC曲线下面积为0.83。分层分析发现有并发症者术前生理评分及POSSUM评分值较高，与无并发症者相比，差异有统计学意义（P<0.01）；对LPD术后并发症的预测, POSSUM评分值在>0.4～0.6时与真实值最相近、最准确；对良、恶性病变，LPD术后的并发症的预测值与实测值的差异无统计学意义（P>0.05）, 其中对恶性肿瘤的预测价值更高；POSSUM评分系统预测男性与女性LPD术后并发症发生率均有价值，且性别间预测值差异无统计学意义。实际的LPD术后并发症发生率为33.3%, POSSUM评分系统预测的并发症发生率为36.6%, 两者差异无统计学意义。POSSUM评分系统预测的病死率是7.0%, 实际的病死率是1.5%, 两者差异无统计学意义；P-POSSUM评分系统预测的病死率是1.6%, 实际的病死率差异无统计学意义。 结论 POSSUM及P-POSSUM评分系统预可较好预测LPD的手术风险, 可用于指导临床决策。
英文摘要
ObjectiveTo evaluate the clinical predictive ability of POSSUM and P-POSSUM scoring system in laparoscopic pancreatoduodenectomy (LPD).MethodsThere were 132 consecutive LPD performed in West China Hospital of Sichuan University from February 2014 to July 2017. The clinical data were retrospective collected, including 12 preoperative physiological variables, 6 operative severity variables, and complications and mortality The postoperative expected mortality and morbidity were calculated by POSSUM and P-POSSUM score, and compared with measured morbidity and mortality. The clinical predictive ability of POSSUM and P-POSSUM system was evaluated by the receiver operating characteristic (ROC) curve and hierarchical analysis.ResultsThe area under ROC curve (AUC) was 0.83. The preoperative physiological score (PS) and POSSUM score of the patients with complications were higher, and the difference was statistically significant (P<0 .01). for the prediction of complications after lpd, the expected value was the most accurate to the measured value when possum score was>0.4-0.6. POSSUM scoring system had no significant difference in predicting the incidence of complications for benign and malignant lesions (P>0.05), with a higher predictive value for malignant tumors. It was valuable in predicting the incidence of complications in male and female, and there was no significant difference in expected value between the sexes. Expected morbidity rate by POSSUM scoring system was 36.6% and measured morbidity rate was 33.3%. The expected and measured morbidities had no significantly differences. The expected mortality was 7.0% and measured mortality rate was 1.5%. The expected and measured mortality had no significantly differences. Expected mortality by P-POSSUM system was 1.6%, the expected and measured mortality had no significantly differences.ConclusionPOSSUM and P-POSSUM scoring system had high value for predicting LPD postoperative morbidity and mortality of LPD patients.
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