Shi Shuai, Lu Cong, Shan Liang, Yan Liang, Liang Yong, Feng Tao, Chen Zun, Chen Xin, Wu Xi, Liu Si-Da, Duan Xiang-Long, Wang Ze-Zheng
Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China.
Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China.
World J Gastrointest Surg. 2024 Nov 27;16(11):3484-3498. doi: 10.4240/wjgs.v16.i11.3484.
Prolonged postoperative ileus (PPOI) delays the postoperative recovery of gastrointestinal function in patients with gastric cancer (GC), leading to longer hospitalization and higher healthcare expenditure. However, effective monitoring of gastrointestinal recovery in patients with GC remains challenging because of the lack of noninvasive methods.
To explore the risk factors for delayed postoperative bowel function recovery and evaluate bowel sound indicators collected an intelligent auscultation system to guide clinical practice.
This study included data from 120 patients diagnosed with GC who had undergone surgical treatment and postoperative bowel sound monitoring in the Department of General Surgery II at Shaanxi Provincial People's Hospital between January 2019 and January 2021. Among them, PPOI was reported in 33 cases. The patients were randomly divided into the training and validation cohorts. Significant variables from the training cohort were identified using univariate and multivariable analyses and were included in the model.
The analysis identified six potential variables associated with PPOI among the included participants. The incidence rate of PPOI was 27.5%. Age ≥ 70 years, cTNM stage (I and IV), preoperative hypoproteinemia, recovery time of bowel sounds (RTBS), number of bowel sounds (NBS), and frequency of bowel sounds (FBS) were independent risk factors for PPOI. The Bayesian model demonstrated good performance with internal validation: Training cohort [area under the curve (AUC) = 0.880, accuracy = 0.823, Brier score = 0.139] and validation cohort (AUC = 0.747, accuracy = 0.690, Brier score = 0.215). The model showed a good fit and calibration in the decision curve analysis, indicating a significant net benefit.
PPOI is a common complication following gastrectomy in patients with GC and is associated with age, cTNM stage, preoperative hypoproteinemia, and specific bowel sound-related indices (RTBS, NBS, and FBS). To facilitate early intervention and improve patient outcomes, clinicians should consider these factors, optimize preoperative nutritional status, and implement routine postoperative bowel sound monitoring. This study introduces an accessible machine learning model for predicting PPOI in patients with GC.
术后肠梗阻（PPOI）会延迟胃癌（GC）患者胃肠道功能的术后恢复，导致住院时间延长和医疗费用增加。然而，由于缺乏非侵入性方法，对GC患者胃肠道恢复进行有效监测仍然具有挑战性。
探讨术后肠功能恢复延迟的危险因素，并评估通过智能听诊系统收集的肠鸣音指标，以指导临床实践。
本研究纳入了2019年1月至2021年1月期间在陕西省人民医院普通外科二病区接受手术治疗及术后肠鸣音监测的120例GC患者的数据。其中，33例报告发生了PPOI。患者被随机分为训练队列和验证队列。通过单因素和多因素分析确定训练队列中的显著变量，并纳入模型。
分析确定了纳入参与者中与PPOI相关的六个潜在变量。PPOI的发生率为27.5%。年龄≥70岁、cTNM分期（I期和IV期）、术前低蛋白血症、肠鸣音恢复时间（RTBS）、肠鸣音次数（NBS）和肠鸣音频率（FBS）是PPOI的独立危险因素。贝叶斯模型在内部验证中表现良好：训练队列[曲线下面积（AUC）=0.880，准确率=0.823，Brier评分=0.139]和验证队列（AUC=0.747，准确率=0.690，Brier评分=0.215）。该模型在决策曲线分析中显示出良好的拟合度和校准度，表明有显著的净效益。
PPOI是GC患者胃切除术后的常见并发症，与年龄、cTNM分期、术前低蛋白血症以及特定的肠鸣音相关指标（RTBS、NBS和FBS）有关。为便于早期干预并改善患者预后，临床医生应考虑这些因素，优化术前营养状况，并实施常规的术后肠鸣音监测。本研究引入了一种可用于预测GC患者PPOI的便捷机器学习模型。
