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

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。

Assessment of Death Risk in Hospital after Hilar Cholangiocarcinoma Operation by Scores of POSSUM,P-POSSUM and APACHE-Ⅱ

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,P0.01）.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,P0.05）.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,P0.01）.The area under ROC curve is 0.759 for POSSUM（P0.05）,0.741 for P-POSSUM（P0.05）,and 0.608 for APACHE-Ⅱ（P0.05）.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.