目的：探索基于二元 Logistics 回归模型分析机器人辅助子宫内膜癌患者术后并发症的危险因素。 方法：回顾性分析 2021 年 5 月—2022 年 5 月在空军军医大学第一附属医院收治的 96 例子宫内膜癌患者的临床资料， 根据手术方式将所有患者分为常规组（n=47）和机器人组（n=49），并比较两组患者并发症发生率。同时，经二元 Logistics 回归模型分析影响术后并发症的危险因素。结果：机器人组术后并发症发生率低于常规组（6.12% Vs 31.91%， P<0.05）。经二元 Logistic 回归模型分析，年龄 >60 岁、BMI>24 kg/m2 、术中出血量 >200 ml、有贫血史、常规手术是影 响患者术后出现并发症的独立危险因素（P<0.05）。利用 Bootstrap 法内验证，预测模型 AUC 为 0.818，特异性 71.8%， 灵敏性 77.8%，95% CI 0.720~0.917。结论：影响机器人辅助子宫内膜癌术后并发症的主要因素为贫血史、手术时间、 BMI、年龄、手术方式，针对合并此类危险因素的患者需采用相应的干预措施，从而降低患者术后并发症，改善预后。

Objective: To explore the risk factors for postoperative complications in patients underwent robot-assisted surgery for endometrial cancer based on binary Logistics regression model. Methods: Clinical data of 96 patients with endometrial cancer admitted to the First Affiliated Hospital of Air Force Military Medical University from May 2021 to May 2022 were retrospectively analyzed. All patients were divided into the conventional group (n=47) and robotic group (n=49) according to different surgical methods, and the complication rate of the two groups was compared. Meanwhile, the risk factors of postoperative complications were analyzed by binary Logistics regression model. Results: The incidence of postoperative complications in the robotic group was lower than that in the conventional group (6.12% Vs 31.91%, P<0.05). The binary Logistic regression analysis results showed that age>60 years old, BMI>24 kg/m2 , intraoperative blood loss>200 ml, history of anemia, and conventional operation were independent risk factors for postoperative complications (P<0.05). Using the Bootstrap method for internal validation, the AUC of the predicted model is 0.818, with specificity of 71.8%, sensitivity of 77.8%, and 95% CI of 0.720-0.917. Conclusion: The main factors affecting postoperative complications of robot-assisted surgery for endometrial cancer are anemia history, operative time, BMI, age, and operation approach. Therefore, appropriate intervention measures should be taken to reduce postoperative complications and improve prognosis of patients.

收稿日期：2023-12-04  录用日期：2024-02-19 

Received Date: 2023-12-04  Accepted Date: 2024-02-19 

基金项目：陕西省重点研发计划项目（2019SF-165）；陕西省卫生健康科研基金项目（2018D068） 

Foundation Item: Key R&D Program of Shaanxi Province (2019SF-165); Health Research Foundation of Shaanxi Province (2018D068) 

通讯作者：王运萍，Email：164020733@qq.com 

Corresponding Author: WANG Yunping, Email: 164020733@qq.com 

引用格式：郭倩，徐佳，綦春蕾，等 . 基于二元 Logistics 回归模型分析机器人辅助子宫内膜癌术后并发症危险因素 [J]. 机器人外 科学杂志（中英文），2024，5（3）：432-438. 

Citation: GUO Q, XU J, QI C L, et al. Analysis of risk factors for postoperative complications in robot-assisted surgery for endometrial cancer based on a binary Logistics regression model [J]. Chinese Journal of Robotic Surgery, 2024, 5(3): 432-438.

[1] 张素伟 , 宫迎迎 , 王云飞 , 等 . 单中心单人机器人 辅助腹腔镜子宫内膜癌分期手术学习曲线及临床 分析 [J]. 机器人外科学杂志 ( 中英文 ), 2022, 3(6): 471-476. 

[2] Scutiero G, Vizzielli G, Taliento C, et al. Influence of uterine manipulator on oncological outcome in minimally invasive surgery of endometrial cancer: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2022, 48(10): 2112-2118. 

[3] 杜亚丽 , 李鹰 , 马锦琪 , 等 . 达芬奇手术机器人与 常规腹腔镜手术治疗子宫内膜癌的比较研究 [J]. 中 国现代手术学杂志 , 2022, 26(5): 396-400. 

[4] Raffone A, Travaglino A, Raimondo D, et al. Laparotomic versus robotic surgery in elderly patients with endometrial cancer: a systematic review and meta-analysis[J]. Int J Gynaecol Obstet, 2022, 157(1): 1-10. 

[5] 张品 , 岳志红 , 刘云鹤 , 等 . 子宫内膜癌腹膜后淋 巴结转移的危险因素及对预后的影响 [J]. 癌症进 展 , 2020, 18(2): 198-201. 

[6] 中国抗癌协会妇科肿瘤专业委员会 . 子宫内膜癌诊 断与治疗指南 (2021 年版 )[J]. 中国癌症杂志 , 2021, 31(6): 501-512. 

[7] 王小琦 , 雷碧波 , 高亚 , 等 . 镜手术后下肢深静脉血栓形成的影响因素 [J]. 子宫内膜癌患者腹腔 血管 与腔内血管外科杂志 , 2021, 7(9): 1099-1104. 

[8] Ishihara B P, Farah D, Fonseca M C M, et al. The risk of developing breast, ovarian, and endometrial cancer in obese women submitted to bariatric surgery: a Meta-analysis[J]. Surg Obes Relat Dis, 2020, 16(10): 1596-1602. 

[9] 中国医师协会微无创医学专业委员会妇科肿瘤专 委会 . 机器人手术治疗子宫内膜癌中国专家共识 (2021 版 )[J]. 机器人外科学杂志 ( 中英文 ), 2022, 3(5): 414-422. 

[10] Scharl S, Sprötge T, Gerken M, et al. Factors influencing treatment decision and guideline conformity in highgrade endometrial cancer patients: a population-based study[J]. Arch Gynecol Obstet, 2022, 305(1): 203-213. 

[11] Findley R, Kooy J, Lester B, et al. Adjuvant chemotherapy and radiation for patients with high-risk stage I endometrial cancer treated with curative intent surgery: impact on recurrence and survival[J]. Int J Gynecol Cancer, 2022, 32(4): 508-516.

[12] 李国鑫 , 周汉虎 , 陈星 . 腹腔镜手术联合腹主动脉 旁淋巴结清扫术治疗子宫内膜癌的疗效及深肌层浸 润影响因素分析 [J]. 癌症进展 , 2022, 20(4): 393-395. 

[13] Siesto G, Romano F, Iedà N P, et al. Survival outcomes after surgical management of endometrial cancer: analysis after the first 10-year experience of robotic surgery in a single center[J]. Int J Med Robot, 2020, 16(6): 1-9. 

[14] 韩文鹤 , 王晓彤 , 陈艳丽 . 乳腺癌术后接受内分泌 治疗的患者发生子宫内膜癌的危险因素分析 [J]. 医 学临床研究 , 2021, 38(3): 428-430, 433. 

[15] 王思源 , 吕晓琳 , 方丽萍 . 腹腔镜与开腹手术治疗 早期子宫内膜癌效果及预后影响因素分析 [J]. 中国 计划生育学杂志 , 2022, 30(11): 2531-2536. 

[16] Fujiwara S, Nishie R, Ueda S, et al. Prognostic significance of peritoneal cytology in low-risk endometrial cancer: comparison of laparoscopic surgery and laparotomy[J]. Int J Clin Oncol, 2021, 26(4): 777-783. 

[17] 郑丽娥 , 吴雅兰 , 谢庆 , 等 . 子宫内膜癌术后影响 因素分析及预后指数模型构建 [J]. 福建医科大学学 报 , 2021, 55(5): 447-450. 

[18] King L J, Young A J, Nagar P M, et al. Outcomes of robotic surgery in morbidly obese patients with endometrial cancer: a retrospective study[J]. J Robot Surg, 2022, 16(3): 569-573. 

[19] Asanoma K, Yahata H, Okugawa K, et al. Impact of obesity on robotic-assisted surgery in patients with stage IA endometrial cancer and a low risk of recurrence: an institutional study[J].J Obstet Gynaecol Res, 2022, 48(12): 3226-3232. 

[20] 黄晓天 , 纪妹 , 赵曌 , 等 . 1 000 例机器人系统妇科 手术的手术并发症及其影响因素分析 [J]. 中华妇产 科杂志 , 2021, 56(5): 341-348. 

[21] DAI Y B, WANG Z Q, WANG J L. Survival of microsatellite-stable endometrioid endometrial cancer patients after minimally invasive surgery: an analysis of the cancer genome atlas data[J]. Gynecol Oncol, 2020, 158(1): 92-98. 

[22] Wedin M, Stålberg K, Marcickiewicz J, et al. Incidence of lymphedema in the lower limbs and lymphocyst formation within one year of surgery for endometrial cancer: a prospective longitudinal multicenter study[J]. Gynecol Oncol, 2020, 159(1): 201-208. 

[23] Chapman C H, Cunha A J, Littell R D, et al. Highdose-rate interstitial brachytherapy for vaginal endometrial cancer recurrence after prior surgery and radiotherapy[J]. Brachytherapy, 2021, 20(3): 536-542. 

[24] Scutiero G, Vizzielli G, Taliento C, et al. Influence of uterine manipulator on oncological outcome in minimally invasive surgery of endometrial cancer: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2022, 48(10): 2112-2118. 

[25] Feigenberg T, Cormier B, Gotlieb W H, et al. Factors associated with an increased risk of recurrence in patients diagnosed with high-grade endometrial cancer undergoing minimally invasive surgery: a study of the society of gynecologic oncology of Canada (GOC) community of practice (CoP)[J]. Gynecol Oncol, 2021, 162(3): 606-612.