E-PASS系統評估結直腸癌手術風險的臨床價值△_《中國普外基礎與臨床雜志》

作者：

胡宗莉 ^1,2 , 黃睿 ^1,2 , 孟玥 ^1,2 , 陳琪 ^1,2 , 汪曉東 ^2,3 ,  李立 ^2,3

1.四川大學華西臨床醫學院/華西醫院(四川成都 610041);;
2.四川大學華西醫院胃腸外科中心MCQ團隊(四川成都 610041);;
3.四川大學華西醫院胃腸外科中心(四川成都 610041);

關鍵詞：

結直腸癌生理能力與手術侵襲度評估并發癥

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目的采用生理能力與手術侵襲度評分系統(E-PASS)預測結直腸癌患者擇期手術風險，探討其在術后并發癥風險預測中的臨床應用價值。方法回顧性分析313例結直腸癌患者使用E-PASS評分系統評估其手術風險，比較E-PASS中的術前風險分數(PRS)、手術侵襲度分數(SSS)和綜合風險分數(CRS)評分與實際手術預后的關系，并探討E-PASS各項指標與術后風險的關系。結果納入分析的患者中，有22例(7.0%)患者發生術后并發癥。患者的年齡(P=0.003)、體重(P=0.019)、腫瘤組織學類型(P=0.033)、Dukes分期(P=0.001)、嚴重心臟疾病(P=0.019)、嚴重肺部疾病(P=0.000)、體能狀態指數(P=0.000)、失血量/體重(P=0.007)、失血量(P=0.001)和手術時間(P=0.000)均與并發癥的發生相關；腫瘤分化程度(P=0.503)、糖尿病(P=0.745)、ASA分級(P=0.085)和手術切口大小(P=0.726)與并發癥的發生無關。有并發癥組的PRS和CRS明顯高于無并發癥組(P lt;0.001)，而SSS在2組間的差異無統計學意義(P=0.059)。結論EPASS評分系統是一個相對方便、有效和易操作的手術風險評估系統，能夠較準確地預測結直腸癌患者術后短期并發癥的發生。

引用本文： 胡宗莉,黃睿,孟玥,陳琪,汪曉東,李立. E-PASS系統評估結直腸癌手術風險的臨床價值△. 中國普外基礎與臨床雜志, 2011, 18(1): 43-47. doi: 復制

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6.	Haga Y, Wada Y, Takeuchi H, et al. Estimation of surgical costs using a prediction scoring system: estimation of physiologic ability and surgical stress [J]. Arch Surg, 2002， 137(4): 481485.
7.	Haga Y, Wada Y, Takeuchi H, et al. Estimation of physiologic ability and surgical stress (EPASS) for a surgical audit in elective digestive surgery [J]. Surgery, 2004， 135(6): 586594.
8.	Hirose J， Mizuta H， Ide J, et al. Evaluation of estimation of physiologic ability and surgical stress (EPASS) to predict the postoperative risk for hip fracture in elder patients [J]. Arch Orthop Trauma Surg, 2008， 128(12): 14471452.
9.	Tang T， Walsh SR， Fanshawe TR, et al. Estimation of physiologic ability and surgical stress (EPASS) as a predictor of immediate outcome after elective abdominal aortic aneurysm surgery [J]. Am J Surg, 2007， 194(2): 176182.
10.	呂東昊, 汪曉東, 陽川華，等. 結直腸腫瘤多學科協作診治模式的數據庫初期建設現狀 [J]. 中國普外基礎與臨床雜志, 2007， 14(6): 713715.
11.	汪曉東, 馮碩, 游小林，等. 結直腸腫瘤多學科協作診治模式下的隨訪體系建設 [J]. 中國普外基礎與臨床雜志, 2007， 14(6): 709712.
12.	Russell SD, Saval MA, Robbins JL, et al. New York Heart Association functional class predicts exercise parameters in the current era [J]. Am Heart J, 2009， 158(4 Suppl): S24S30.
13.	Lonit D. Pulmonary function tests in bronchial asthma [J]. Pneumologia, 2008， 57(2): 7074.
14.	Martenson JA, Lipsitz SR, Lefkopoulou M, et al. Results of combined modality therapy for patients with anal cancer (E7283). An Eastern Cooperative Oncology Group study [J]. Cancer, 1995, 76(10): 17311736.
15.	Hirose J， Mizuta H， Ide J, et al. EPASS for predicting postoperative risk with hip fracture: a multicenter study [J]. Clin Orthop Relat Res, 2008， 466(11): 28332841.
16.	Tang TY, Walsh SR, Fanshawe TR, et al. Comparison of riskscoring methods in predicting the immediate outcome after elective open abdominal aortic aneurysm surgery [J]. Eur J Vasc Endovasc Surg， 2007， 34(5): 505513.
17.	Oka Y， Nishijima J， Oku K, et al. Usefulness of an estimation of physiologic ability and surgical stress (EPASS) scoring system to predict the incidence of postoperative complications in gastrointestinal surgery [J]. World J Surg, 2005， 29(8): 10291033.
18.	Dukes CE. The classification of cancer of the rectum [J]. Dis Colon Rectum, 1980， 23(8): 605611.
19.	Sakurai Y， Uyama I. Neoadjuvant and postoperative adjuvant anticancer chemotherapy in gastric cancer [J]. Ann Surg Oncol, 2009， 16(5): 14441445.
20.	汪曉東, 譚嘉熙，楊文旭，等. 多學科協作診治模式下新輔助化療聯合手術治療直腸癌的隨機對照研究 [J]. 中國普外基礎與臨床雜志， 2008， 15(12): 937940.
21.	汪曉東, 邱萌, 李亞倫, 等. 多學科協作診治模式下結直腸癌不同周期新輔助化療聯合手術的方案研究 [J]. 中國普外基礎與臨床雜志， 2008， 15(3): 210214, 217.
22.	Wilmore DW， Kehlet H. Recent advances： management of patients in fast track surgery [J]. BMJ， 2001， 322(7284)： 473476．.
23.	汪曉東, 謝堯, 肖軍，等. 快速流程在結直腸外科手術后管理中的應用 [J]. 中國普通外科雜志, 2008， 17(4): 394396.

1. Ferjani AM, Griffin D, Stallard N, et al. A newly devised scoring system for prediction of mortalityin patients with colorectal cancer: a prospective study [J]. Lancet Oncol, 2007， 8(4): 317322.
2. Alves A, Panis Y, Mantion G, et al. The AFC score: validation of a 4item predicting score of postoperative mortality after colorectal resection for cancer or diverticulitis: results of a prospective multicenter study in 1 049 patients [J]. Ann Surg, 2007， 246(1): 9196.
3. Kulkarni SV, Naik AS, Subramanian N Jr. APACHEⅡ scoring system in erforative peritonitis [J]. Am J Surg, 2007， 194(4): 549552.
4. Haga Y, Ikei S, Ogawa M. Estimation of Physiologic Ability and Surgical Stress (EPASS) as a new prediction scoring system for postoperative morbidity and mortality following gastrointestinal surgery [J]. Surg Today, 1999， 29(3): 219225.
5. Haga Y, Ikei S, Wada Y, et al. Evaluation of an Estimation of Physiologic Ability and Surgical Stress (EPASS) scoring system to predict postoperative risk: a multicenter prospective study [J]. Surg Today, 2001， 31(7): 569574.
6. Haga Y, Wada Y, Takeuchi H, et al. Estimation of surgical costs using a prediction scoring system: estimation of physiologic ability and surgical stress [J]. Arch Surg, 2002， 137(4): 481485.
7. Haga Y, Wada Y, Takeuchi H, et al. Estimation of physiologic ability and surgical stress (EPASS) for a surgical audit in elective digestive surgery [J]. Surgery, 2004， 135(6): 586594.
8. Hirose J， Mizuta H， Ide J, et al. Evaluation of estimation of physiologic ability and surgical stress (EPASS) to predict the postoperative risk for hip fracture in elder patients [J]. Arch Orthop Trauma Surg, 2008， 128(12): 14471452.
9. Tang T， Walsh SR， Fanshawe TR, et al. Estimation of physiologic ability and surgical stress (EPASS) as a predictor of immediate outcome after elective abdominal aortic aneurysm surgery [J]. Am J Surg, 2007， 194(2): 176182.
10. 呂東昊, 汪曉東, 陽川華，等. 結直腸腫瘤多學科協作診治模式的數據庫初期建設現狀 [J]. 中國普外基礎與臨床雜志, 2007， 14(6): 713715.
11. 汪曉東, 馮碩, 游小林，等. 結直腸腫瘤多學科協作診治模式下的隨訪體系建設 [J]. 中國普外基礎與臨床雜志, 2007， 14(6): 709712.
12. Russell SD, Saval MA, Robbins JL, et al. New York Heart Association functional class predicts exercise parameters in the current era [J]. Am Heart J, 2009， 158(4 Suppl): S24S30.
13. Lonit D. Pulmonary function tests in bronchial asthma [J]. Pneumologia, 2008， 57(2): 7074.
14. Martenson JA, Lipsitz SR, Lefkopoulou M, et al. Results of combined modality therapy for patients with anal cancer (E7283). An Eastern Cooperative Oncology Group study [J]. Cancer, 1995, 76(10): 17311736.
15. Hirose J， Mizuta H， Ide J, et al. EPASS for predicting postoperative risk with hip fracture: a multicenter study [J]. Clin Orthop Relat Res, 2008， 466(11): 28332841.
16. Tang TY, Walsh SR, Fanshawe TR, et al. Comparison of riskscoring methods in predicting the immediate outcome after elective open abdominal aortic aneurysm surgery [J]. Eur J Vasc Endovasc Surg， 2007， 34(5): 505513.
17. Oka Y， Nishijima J， Oku K, et al. Usefulness of an estimation of physiologic ability and surgical stress (EPASS) scoring system to predict the incidence of postoperative complications in gastrointestinal surgery [J]. World J Surg, 2005， 29(8): 10291033.
18. Dukes CE. The classification of cancer of the rectum [J]. Dis Colon Rectum, 1980， 23(8): 605611.
19. Sakurai Y， Uyama I. Neoadjuvant and postoperative adjuvant anticancer chemotherapy in gastric cancer [J]. Ann Surg Oncol, 2009， 16(5): 14441445.
20. 汪曉東, 譚嘉熙，楊文旭，等. 多學科協作診治模式下新輔助化療聯合手術治療直腸癌的隨機對照研究 [J]. 中國普外基礎與臨床雜志， 2008， 15(12): 937940.
21. 汪曉東, 邱萌, 李亞倫, 等. 多學科協作診治模式下結直腸癌不同周期新輔助化療聯合手術的方案研究 [J]. 中國普外基礎與臨床雜志， 2008， 15(3): 210214, 217.
22. Wilmore DW， Kehlet H. Recent advances： management of patients in fast track surgery [J]. BMJ， 2001， 322(7284)： 473476．.
23. 汪曉東, 謝堯, 肖軍，等. 快速流程在結直腸外科手術后管理中的應用 [J]. 中國普通外科雜志, 2008， 17(4): 394396.

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E-PASS系統評估結直腸癌手術風險的臨床價值△

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《中國普外基礎與臨床雜志》

E-PASS系統評估結直腸癌手術風險的臨床價值△

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