| 刘夕水1 苏东玮1 施俊义1△ 宗明2 俞文隆2 张宝华2 张永杰2.POSSUM、P-POSSUM 和APACHE-Ⅱ评分对肝门部胆管癌手术后
住院死亡风险评估的对比研究[J].,2011,11(8):1489-1494 |
| POSSUM、P-POSSUM 和APACHE-Ⅱ评分对肝门部胆管癌手术后
住院死亡风险评估的对比研究 |
| Assessment of Death Risk in Hospital after Hilar CholangiocarcinomaOperation by Scores of POSSUM ,P-POSSUM and APACHE-Ⅱ |
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| DOI： |
| 中文关键词: 胆管癌 风险评估 手术死亡率 POSSUM P-POSSUM APACHE-Ⅱ |
| 英文关键词: cholangiocarcinoma, risk assessment, perioperative mortality, POSSUM, P-POSSUM, APACHE-Ⅱ |
| 基金项目: |
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| 中文摘要: |
| 目的：通过利用POSSUM、P-POSSUM 和APACHE-Ⅱ评分对我院行手术治疗的肝门部胆管癌病例的术后住院死亡率的预
测进行预测，评价各评分的预测能力，为肝门部胆管癌术后死亡风险寻求有效的评估方法。方法：收集了2002 年1 月～2007 年
12 月期间在东方肝胆外科医院接受手术治疗的348 例肝门部胆管癌的病例资料，统计其手术后的住院死亡率；统计学方法：所有
的数据通过SPSS15.0 for windows、Medcalc9.2.10 for windows 进行分析处理，计量资料经t 检验、计数资料以x2 检验和Z 检验，
P＜0.05 为有统计学意义；O:E 值和ROC 曲线用来评价评分方法的判别能力。结果：348 例患者的术后有6 例发生住院期间死亡，
死亡率为1.7％,POSSUM 评分预测的住院死亡率为9.3％（33 例），两者之间的差异有统计学意义（x2=19.80,df=1,P＜0.01）；
P-POSSUM 评分预测的住院死亡率2.8％（10 例），两者之间的差异无统计学意义（x2=1.02,df=1,P＞0.05）；APACHE-Ⅱ评分预测的
住院死亡率9.2％（32 例），两者之间的差异有统计学意义（x2=18.82,df=1,P＜0.01）。POSSUM、P-POSSUM 和APACHE-Ⅱ评分对应
的ROC 曲线下面积分别为0.759、0741 和0.608。结论：P-POSSUM 评分能很好的预测肝门部胆管癌手术的术后住院死亡率，
POSSUM 和APACHE-Ⅱ评分不能准确的预测，明显高估了术后死亡风险。 |
| 英文摘要: |
| Objective: To compare the value of POSSUM, P-POSSUM, and APACHE- Ⅱ score in prediction of perioperative
death in patients with hilar cholangiocarcinoma underwent resection.Methods: Three hundred forty eight patients with hilar
cholangiocarcinoma admitted to Easten Hepatobiliary Hospital from January 1,2002,to December 31,2007,who underwent resection were
evaluated using POSSUM, P-POSSUM, and APACHE-Ⅱscore. The outcome meaures was perioperative death within 30 days.All datas
analysed by SPSS15.0 for windows and Medcalc9.2.10 for windows.t-test for means,x2-test for chi-qu, Z-test for the area under ROC
curve. significance level for P=0.05. The ROC curve and O:E used to estimate the predictive ability of the scoring systems.Result: The
actual mortality was 1.7％(6 cases).Expected mortality was 9.3％(33 cases) for POSSUM score. The differentia between actual mortality
and predictive mortality was significant (x2=19.80,df=1,P＜0.01). Expected mortality was 2.8％(10 cases) for P-POSSUM score.The
differentia between actual mortality and predictive mortality was non-significant(x2=1.02,df=1,P＞0.05). Expected mortality was 9.2％(32
cases) for APACHE-Ⅱscore.The differentia between actual mortality and predictive mortality was significant (x2=18.82,df=1, P＜0.01).
The area under ROC curve is 0.759 for POSSUM (P＜0.05), 0.741 for P-POSSUM (P＜0.05), and 0.608 for APACHE-Ⅱ (P＞0.05).
Conclusions:P-POSSUM score was useful in predicting perioperative mortality for patients with hilar cholangiocarcinoma.POSSUM and
APACHE-Ⅱwere unuseful in predicting perioperative mortality, and overrated the mortality. |
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