食管癌切除术后围术期死亡危险因素的分析及预测模型的建立

表1 民族及年龄分布

民族	n	百分比(%)	备注
汉族	394	46.35
哈萨克族	225	26.47
维吾尔族	193	22.71
回族	21	2.47
蒙古族	12	1.41
俄罗斯族	2	0.24
朝鲜族	1	0.12
柯尔克孜族	1	0.12
锡伯族	1	0.12
合计	850	100.00
性别分布特征
男	584	68.70	平均年龄(岁): 59.97±9.45(32-81)
女	266	31.30	平均年龄(岁): 60.10±8.44(31-83)
年龄(岁)
<40	12	1.41
40-59	362	42.59
60-69	359	42.24
≥70	117	13.76
合计	850	100.00	整组平均年龄(岁): 60.01±9.14(31-83)
吸烟年数≥20年	239	28.10	肺功能中至重度损害或障碍22例(2.59%)

表2 影响食管癌手术死亡率的因素及量化赋值结果

变量	因素	赋值
X1	Sex	Male(1), female(2)
X2	Nationality	Han(1), Kazak(2), Uyghur(3), Hui(4), Mongolian(5), other(6)
X3	Age	<40 yr(1), 40-49 yr(2), 50-59 yr(3), 60-69 yr(4)>70 yr(5)
X4	BMI	≤18.4(1), 18.5-24.9(2), 25.0-29.9(3), 30.0-34.0(4), 35.0-39.9(5)
X5	Duration of symptom	<3 mo(1), 4-12 mo(2), >12 mo(3)
X6	History of long term severe smoking	No smoking(0), <5 yr(1), 5-10 yr(2), 10-15 yr(3), >15 yr(4)
X7	Preoperative pulmonary function	Normal(0), mild damaged(1), middle damaged(2), severe damaged(3)
X8	History of diabetes or coronary heart disease or hypertention	Without(0), HBP(1), DM(2), HD(3), Coronary artery disease and Stent implantation state(4), HBP and DM(5), HBP and HD(6), withHD、DM、HBP(7)
X9	Preoperative albumin	<35.0 g/L(1), 35.0-50.0 g/L(2), >50.0 g/L(3);
X10	Preoperative hemoglobin	male <60 g/L(1), 60-90 g/L(2), 90-120(3), 120-160 g/L(4), >160 g/L(5); female <60g/L(1), 60-90 g/L(2), 90-110(3), 110-150 g/L(4), >150 g/L(5)
X11	Position of tumor	lower segment thorax(1), middle segment in thorax(2), superior segment in thorax(3); Double primary cancer(4)
X12	Length of lesion	<3 cm(1), 3-5 cm(2), >5 cm(3)
X13	Fashion of resect	left posteroiateral incision(1), right thoracic and abdomen incision(2), Cervix, thoracic and abdominal incision(3), Thoracoabdominal approach(4), VATS(5), VATS + Laparoscope(6), laparotomy(7); The left carotid left chest(8)
X14	Organ reconstructed	stomach(1), Jejunum(2)
X15	Fashion of anastomose	Machanical(1), handwork(2)
X16	Position of anastomose	cervix(1), Superior to aortic arch(2), inferior to aortic arch(3), Right thorax(4)
X17	TNM stages of tumor	TisN0M0(0), T1aN0M0(1), T1bN0M0(2), T1bN1-2M0(3), T1bN3M0(4), T2N0M0(5), T2 N1M0(6), T2 N2 M0(7), T2 N3 M0(8), T3 N0M0(9), T3 N1M0(10), T3 N2M0(11), T3 N3M0(12), T4aN1M0(13),T4bN0-1M0(14), T-N-M1(15);
X18	Duration of operation	<3 h(1), >3 h(2)
X19	Range of Surgical resection	<4 cm(1), 4-6 cm(2), 7-8 cm(3), >8 cm(4)
X20	Vascular tumor thrombus	Negative(1), positive(2)
X21	Surgical stump	Negative(1), upper stump positive(2), lower stump positive(3)
X22	Pathological type	Squamous Cells Carcinoma- SqCa(1), adenocarcinoma(2), adenosquamous carcinoma (3), undifferentiated carcinoma or carcinosarcoma(4), other therioma(5)
X23	Degree of differentiation	Well-differentiated(G1)(1), moderately differentiated(G2)(2); poorly differentiated(G3)(3); undifferentiation(G4)(4);G1-G2(5), G2-G1(6), G3-G2(7), G2-G3(8), G2-G3/G1-G2(9), Gx(10)
X24	Extent of lymphnode dissection	0(1), 1-2(1), 3-6(2), >6(3)
X25	Year of operation	2002-2009年(1), 2010/2015-12(2)
X26	Intraoperative blood transfusion	Yes(1), No(2)
X27	Postoperative albumin	<35.0 g/L (1), 35.0-50.0 g/L(2), >50.0 g/L(3)
X28	Postoperative albumin	male <60 g/L(1), 60-90 g/L(2), 90-120(3), 120-160 g/L(4), >160 g/L(5); female <60 g/L(1), 60-90 g/L(2), 90-110(3), 110-150 g/L(4), >150 g/L(5)
X29	Amount of bleeding during operation	100-300 mL(1), 300-500 mL(2), 500-800 mL(3), 800-1000 mL(4), >1000 mL(5)
X30	Enteral nutrition time(the day after the operation	No(1); first day(2); 2nd day(3): 3th day(4); 4th day(5); 5th day(6); 6th day(7); 7th day(8); >7th day(9)
X31	ICU treatment time	No(1); 1 d(2); 2 d(3); 3 d(4); 4 d(5); 5 d(6); 6 d(7); 7 d(8); >7 d(9)
X32	arhythmia	Yes(1), No(2)
X33	Pneumonia、pulmonary infection	Yes(1), No(2)
X34	Urinary tract infections	Yes(1), No(2)
X35	Status asthmaticus	Yes(1), No(2)
X36	Severe pneumonia	Yes(1), No(2)
X37	Unilateral pleural effusion	Yes(1), No(2)
X38	Chest infection	Yes(1), No(2)
X39	Atelectasis	Yes(1), No(2)
X40	Bilateral pleural effusion	Yes(1), No(2)
X41	Pneumothorax	Yes(1), No(2)
X42	Hydropneumothorax	Yes(1), No(2)
X43	Pulmonary embolism	Yes(1), No(2)
X44	Abdominal infection、ascites	Yes(1), No(2)
X45	Infectious shock	Yes(1), No(2)
X46	Cardiogenic shock	Yes(1), No(2)
X47	Sudden cardiac death	Yes(1), No(2)
X48	Upper gastrointestinal bleeding	Yes(1), No(2)
X49	Hemorrhagic shock	Yes(1), No(2)
X50	MODS	Yes(1), No(2)
X51	Renal Failure	Yes(1), No(2)
X52	Electrolyte imbalance	Yes(1), No(2)
X53	Pyothorax	Yes(1), No(2)
X54	Anastomotic fistu	Yes(1), No(2)
X55	Chylopleura	Yes(1), No(2)
X56	Abdominal abscess	Yes(1), No(2)
X57	Central system failure	Yes(1), No(2)
X58	Failure of respiration	Yes(1), No(2)
X59	Circulatory failure	Yes(1), No(2)
X60	Respiratory failure and circulatory failure	Yes(1), No(2)
X61	Myocardial infarction	Yes(1), No(2)
X62	Hypoxic-ischemic syndrome	Yes(1), No(2)
X63	Innutrition、Hypoproteinem	Yes(1), No(2)
X64	Surgical wound infection	Yes(1), No(2)

表3 单因素Logistic回归模型分析结果

编号	变量名	B	S.E	Wald	df	sig	Exp(B)OR = OD1/OD2 = Exp(B)
1	X2民族	-0.488	0.210	5.367	1	0.021	0.614
2	X3年龄			18.272	4	0.001
	X3年龄(2)	-2.657	1.043	6.496	1	0.011	0.070
	X3年龄(3)	-1.224	0.414	8.745	1	0.003	0.294
	X3年龄(4)	-1.452	0.403	12.943	1	0.000	0.234
3	X8合并症	-3.033	0.164	342.391	1	0.000	0.048
4	X10术前血红蛋白			5.756	4	0.022
	X10(1)	2.708	1.506	3.235	1	0.042	15.000
	X10(2)	2.708	1.506	3.235	1	0.042	15.000
5	X13手术切除方式	0.365	0.115	10.167	1	0.001	1.441
6	X15吻合方式(1)	-4.076	0.713	32.663	1	0.000	0.017
7	X16吻合水平	-0.747	0.301	6.171	1	0.013	0.536
9	X25手术年代(1)	-0.787	0.348	5.124	1	0.024	0.455
10	X27术后白蛋白			9.736	2	0.008
	X27术后白蛋白(1)	1.911	0.733	6.795	1	0.009	6.760
	X27术后白蛋白(2)	2.661	0.854	9.709	1	0.002	14.312
11	X30肠内营养时间	-0.443	0.127	12.153	1	0.000	0.642
12	X31ICU治疗时间			58.252	8	0.000
	X31ICU治疗时间(1)	-2.729	0.547	24.855	1	0.000	0.065
	X31ICU治疗时间(2)	-2.340	0.561	17.390	1	0.000	0.096
13	X32心律失常(1)	-2.492	0.377	43.601	1	0.000	0.083
14	X33肺炎、肺部感染(1)	-2.179	0.605	12.970	1	0.000	0.113
15	X36重症肺炎(1)	-1.691	0.808	4.378	1	0.036	0.184
16	X37单侧胸腔积液(1)	-0.657	0.332	3.910	1	0.048	0.519
17	X40双侧胸腔积液	2.444	0.559	19.097	1	0.000	312.765
18	X45感染性休克(1)	-2.678	0.928	8.325	1	0.004	0.069
19	X50MODS(1)	-5.310	0.785	45.718	1	0.000	0.005
20	X54吻合口瘘(1)	-1.306	0.421	9.610	1	0.002	0.271
21	X55乳糜胸(1)	-1.424	0.477	8.911	1	0.003	0.241
22	X58呼吸衰竭(1)	-2.412	0.525	21.151	1	0.000	0.090
23	X59循环衰竭(1)	-1.826	0.819	4.968	1	0.026	0.161
24	X60呼吸循环衰竭(1)	-3.779	1.236	9.346	1	0.002	0.023
25	X62缺血缺氧综合征(1)	3.059	1.424	4.617	1	0.032	21.316

表4 多因素Logistic回归模型分析结果

编号	变量名	B	S.E.	Wald	df	sig	Exp(B) OR = OD1/OD2 = Exp(B)	95%CI
								下限	上限
1	X25手术年代(1)	-2.951	0.815	13.113	1	0.000	0.052	0.011	0.258
2	X27术后白蛋白	-1.922	0.484	15.802	1	0.000	0.146	0.057	0.377
3	X30肠内营养	-0.445	0.209	4.509	1	0.034	0.641	0.425	0.966
4	X32心律失常(1)	2.066	0.497	17.255	1	0.000	7.891	2.977	20.914
5	X50MODS(1)	-4.313	1.213	12.631	1	0.000	0.013	0.001	0.145
6	X55乳糜胸(1)	-2.333	0.744	9.823	1	0.002	0.097	0.023	0.417
7	X58呼吸衰竭(1)	2.689	0.703	14.625	1	0.000	14.723	3.710	58.427
8	常数	8.999	2.293	15.403	1	0.000	8097.677