腹部创伤剖腹探查术后发生迟发性腹壁切口疝的危险因素分析及预测模型构建  

Risk factors for delayed incisional hernia of the abdominal wall after exploratory laparotomy for abdominal trauma patients and establishment of a prediction model

作　　者：黄兆峰 朱烈烈 陈大庆[1] 金灿[1] 杨越涛[1] Huang Zhaofeng;Zhu Lielie;Chen Daqing;Jin Can;Yang Yuetao(Department of Emergercny Medicine,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang325088,China;Department of Rehabilitation,Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou,Zhejiang325029,China)

机构地区：[1]温州医科大学附属第二医院急诊医学科,温州325088 [2]温州市中医院康复科,温州325029

出　　处：《创伤外科杂志》2023年第4期267-273,共7页Journal of Traumatic Surgery

摘　　要：目的探讨腹部创伤传统剖腹探查术后患者发生迟发性腹壁切口疝的危险因素,构建风险预测模型。方法回顾性分析2014年1月—2019年12月温州医科大学附属第二医院急诊医学科收治的280例因创伤导致腹腔脏器损伤合并严重腹壁损伤患者。其中男性180例,女性100例;年龄25~85岁,平均58.6岁。致伤原因:道路交通伤、钝器击打伤、高处坠落伤、挤压伤等。患者均行剖腹探查术。按术后2年内发生腹壁切口疝与否分为发生腹壁疝组(39例)和未发生腹壁疝组(241例)。以单因素及多因素Logistic回归分析发生迟发性腹壁切口疝的独立危险因素,并据此建立风险预测模型,Hosmer-Lemeshow检验评估模型拟合度,受试者工作特征(receiver operating characteristic,ROC)曲线评估回归模型的预测价值。结果本研究周期内全组迟发性腹壁切口疝发生率13.93%。发生腹壁疝组的≥60岁比例、合并腹内压增高因素构成比和主刀为非疝专科医师比例方面均高于未发生腹壁疝组(P均<0.05),而高体质量指数(body mass index,BMI)人数构成比和合并术后早期切口感染方面,发生腹壁疝组也高于未发生腹壁疝组,虽然未达到统计学意义(P>0.05),但达到了单因素分析的筛选界值(P<0.1)。而在性别构成、修正创伤评分、年龄校正的查尔森慢病指数、切口类型构成比、手术时间、住院时间、糖化血红蛋白和低蛋白血症占比方面,发生腹壁疝组与未发生腹壁疝组间差异无统计学意义(P>0.05)。年龄≥60岁、BMI≥25kg/m^(2)、合并腹内压增高因素和合并术后早期切口感染均是患者术后2年内发生腹壁切口疝的独立危险因素[OR(95%CI)分别为4.368(1.896~10.059),2.491(1.096~5.662),2.758(1.283~5.926)和6.819(2.000~23.242),P均<0.05],而主刀为疝专科医师则是患者术后2年内发生腹壁疝的独立保护因素[OR(95%CI)为0.067(0.017~0.264),P<0.05]。据此构建的风险预测模型为:Logit(P)=-3.Objective To explore the risk factors for delayed incisional hernia of the abdominal wall after exploratory laparotomy in patients with abdominal trauma and to establish a risk prediction model.Methods Clini-cal data of 280 patients with abdominal organ injuries and severe abdominal wall injuries were retrospectively collect-ed in the Department of Emergercny Medicine,Second Affiliated Hospital of Wenzhou Medical University from Jan.2014 to Dec.2019.All patients underwent traditional laparotomy.Among them,180 were male and 100 were fe-male,with the mean age of 58.6 years,range 25-85 years.The causes of injuries included road traffic accidents,blunt violence,falls from height and crush injuries.Based on whether abdominal wall incisional hernia developed in 2 years after laparotomy,patients were divided into hernia group(n=39)and non-hernia group(n=241).The in-dependent risk factors for developing delayed abdominal wall incisional hernia were identified by univariate and mul-tivariate logistic regression analysis,and a risk prediction model was established.Hosmer-Lemeshow test was adopt-ed to evaluate the fitness of the model,and the receiver operating characteristic(ROC)curve to evaluate the predic-tive value of the regression model.Results The incidence of delayed incisional hernia of the abdominal wall in this study was 13.93%.The proportions of patients with age≥60 years,high risk of increased intra-abdominal pressure(IAP)and chief surgeon not being hernia specialist were much higher in the hernia group(all P<0.05),while BMI≥25 kg/m^(2)and early incision infection,though revealed no significant difference between two groups,reached the threshold for univariate logistic regression analysis(P<0.1).As for age,revised trauma score,age-adjusted Charlson comorbidity index,incision types,operation time,length of hospital stay,HbA1c and hypoproteinemia showed no significant differences between two groups(all P>0.05 and P>0.1).Multivariate logistic regression a-nalysis confirmed that age≥60 years(OR 4.368,95%CI 1.

关 键 词：腹部创伤 剖腹探查术 迟发性腹壁切口疝 危险因素 预测模型 

分 类 号：R656.3[医药卫生—外科学]