腹腔镜中转开腹胆囊切除术后手术部位感染风险预测模型构建及评价  

Establishment of risk prediction model for postoperative surgical site infection in patients undergoing laparoscopy converted to open cholecystectomy and its effect

作　　者：张红霞 张一帆[1] 王凯 宋宗工 闫小飞 郑金琳 ZHANG Hong-xia;ZHANG Yi-fan;WANG Kai;SONG Zong-gong;YAN Xiao-fei;ZHENG Jin-lin(Nanyang Second People′s Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市第二人民医院微创外科,河南南阳473000

出　　处：《中华医院感染学杂志》2022年第22期3434-3437,共4页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210977)。

摘　　要：目的构建腹腔镜中转开腹胆囊切除术后手术部位感染风险预测模型,为筛选手术部位感染高危人群提供技术支持。方法选取2015年1月-2021年8月南阳市第二人民医院微创外科收治的腹腔镜中转开腹胆囊切除术患者216例,根据是否发生手术部位感染(SSI)分为SSI组54例和非SSI组162例。收集患者临床资料,筛选出SSI的危险因素并构建SSI早期风险预测模型。绘制风险预测模型的受试者工作曲线(ROC),计算ROC曲线下面积(AUC)、灵敏度、特异度,并通过临床病例验证,评价风险预测模型的预测效果。结果SSI组和非SSI组患者在C-反应蛋白(CRP)、术前行经内镜逆行性胰胆管造影术(ERCP)或经皮经肝胆管引流术(PTBD)方面差异具有统计学意义(P<0.05)。术前行ERCP、术前行PTBD是腹腔镜中转开腹胆囊切除术后患者发生SSI的影响因素(P<0.05)。本研究基于多因素Logistic回归模型进行联合预测,发现CRP、术前行ERCP、术前行PTBD联合可提高早期预测SSI准确性(AUC=0.812)(P<0.05)。30例患者初步验证结果显示该风险预测模型灵敏度74.09%,特异度85.21%,阳性预测值70.00%,阴性预测值90.00%。结论CRP、术前行ERCP、术前行PTBD是患者术后SSI的危险因素,由这些危险因素构建的模型对SSI风险预测有较好的效果。OBJECTIVE To establish the risk prediction model for postoperative surgical site infection in patients undergoing laparoscopy converted to open cholecystectomy so as to provide technical support for screening of high-risk population with surgical site infection(SSI).METHODS A total of 216 patients who underwent laparoscopy converted to open cholecystectomy in department of minimally invasive surgery of Nanyang Second People′s Hospital from Jan 2015 to Aug 2021 were enrolled in the study and divided into the SSI group with 54 cases and the non-SSI group with 162 cases according to the status of SSI.The clinical data were collected from the patients,the risk factors for SSI were screened out,and the risk prediction model for SSI in early stage was established.The receiver operating characteristic(ROC)curves were drawn for the risk prediction model,the areas under ROC curves(AUCs),sensitivity and specificity were calculated,and the predictive effect of the risk prediction model was evaluated by verification of clinical cases.RESULTS There were significant differences in the C-reactive protein(CRP),preoperative endoscopic retrograde cholangiopancreatography(ERCP)or percutaneous transhepatic bile duct drainage(PTBD)between the SSI group and the non-SSI group(P<0.05).The preoperative ERCP and preoperative PTBD were the influencing factors for postoperative SSI in the patients undergoing laparoscopy converted to open cholecystectomy(P<0.05).The study based on the model combined with multivariate logistic regression model showed that CRP,preoperative ERCP and preoperative PTBD may raise the accuracy in prediction of SSI(AUC=0.812)(P<0.05).The result of preliminary verification for 30 patients indicated that the sensitivity of the risk prediction model was 74.09%,with the specificity 85.21%,the positive predictive value 70.00%,the negative predictive value 90.00%.CONCLUSION The CRP,preoperative ERCP and preoperative PTBD are the risk factors for postoperative SSI.The model established based on the risk factors show rema

关 键 词：开腹胆囊切除术 腹腔镜 手术部位感染 危险因素 风险预测模型 预测效果 

分 类 号：R619.3[医药卫生—外科学]