腹腔镜经腹膜前腹股沟疝修补术后慢性疼痛的风险预测模型  

Risk prediction model for chronic pain after laparoscopic preperitoneal inguinal hernia repair

作　　者：于志远 杨诗语 柳博文 张旭[1] 孙岩[1] YU Zhiyuan;YANG Shiyu;LIU Bowen;ZHANG Xu;SUN Yan(Seventh Department of General Surgery,The Second Affiliated Hospital of Harbin Medical University,Harbin 150081,P.R.China)

机构地区：[1]哈尔滨医科大学附属第二医院普外七科,哈尔滨150081

出　　处：《中国普外基础与临床杂志》2022年第6期761-767,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费第二届中国健康长寿创新大赛(项目编号:2021-JKCS-006)。

摘　　要：目的探讨腹腔镜经腹膜前腹股沟疝修补术(transabdominal preperitoneal hernia repair,TAPP)后慢性腹股沟区疼痛(chronic postoperative inguinal pain,CPIP)发病的风险因素,建立风险预测模型并进行验证,评估其预测效果。方法回顾性分析接受TAPP手术的362例患者的临床资料,分为模型组(n=300)和验证组(n=62)。运用单因素及logistic回归多因素分析筛选模型组CPIP的危险因素,建立风险预测模型并验证模型的预测效能。结果362例患者术后6个月时CPIP的发生率为27.9%(101/362)。单因素分析结果显示:性别(χ^(2)=12.055,P=0.001)、年龄(t=–4.566,P<0.01)、术前疼痛(χ^(2)=44.686,P<0.01)和术后1周早期疼痛(χ^(2)=150.795,P<0.01)与CPIP相关。多因素logistic回归分析结果显示:性别、年龄、术前疼痛、术后1周早期疼痛和下腹部手术史是CPIP发生的独立风险预测因素。风险预测模型的受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)为0.933,其95%CI为(0.898,0.967),取最佳截断值0.129,对应的特异度为87.6%,敏感度为91.5%。代入验证组数据显示模型预测准确率为91.9%(57/62),特异度为90.7%,敏感度为94.7%。结论女性、年龄≤64岁、术前疼痛、术后1周早期疼痛和无下腹部手术史是TAPP术后CPIP发病的独立危险因素,在此基础上建立的风险预测模型预测效能较好,可进一步指导临床工作。Objective To explore the risk factors of chronic postoperative inguinal pain(CPIP)after transabdominal preperitoneal hernia repair(TAPP),establish and verify the risk prediction model,and then evaluate the prediction effectiveness of the model.Methods The clinical data of 362 patients who received TAPP surgery was retrospectively analyzed and divided into model group(n=300)and validation group(n=62).The risk factors of CPIP in the model group were screened by univariate analysis and multivariate logistic regression analysis,and the risk prediction model was established and tested.Results The incidence of CPIP at 6 months after operation was 27.9%(101/362).Univariate analysis showed that gender(χ^(2)=12.055,P=0.001),age(t=–4.566,P<0.01),preoperative pain(χ^(2)=44.686,P<0.01)and early pain at 1 week after operation(χ^(2)=150.795,P<0.01)were related to CPIP.Multivariate logistic regression analysis showed that gender,age,preoperative pain,early pain at 1 week after operation,and history of lower abdominal surgery were independent risk predictors of CPIP.The area under curve(AUC)of the receiver operating characteristic(ROC)of the risk prediction model was calculated to be 0.933[95%CI(0.898,0.967)],and the optimal cut-off value was 0.129,while corresponding specificity and sensitivity were 87.6%and 91.5%respectively.The prediction accuracy,specificity and sensitivity of the model were 91.9%(57/62),90.7%and 94.7%,respectively when the validation group data were substituted into the prediction model.Conclusion Female,age≤64 years old,preoperative pain,early pain at 1 week after operation and without history of lower abdominal surgery are independent risk factors for the incidence of CPIP after TAPP,and the risk prediction model established on this basis has good predictive efficacy,which can further guide the clinical practice.

关 键 词：腹腔镜经腹膜前疝修补术 慢性疼痛 腹股沟疝 风险预测模型 

分 类 号：R656.21[医药卫生—外科学]