个体化预测肛周脓肿切开引流术后肛瘘发生的列线图模型构建  

Construction of a nomogram model for personalized prediction of anal fistula occurrence after incision and drainage of perianal abscess

作　　者：严昌林 孙兴伟 赵璐 YAN Changlin;SUN Xingwei;ZHAO Lu(Department of Anorectal,Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang,Shanxi 712000,China)

机构地区：[1]陕西中医药大学附属医院肛肠科,陕西咸阳712000 [2]西安市中医医院肛肠科 [3]陕西省第四人民医院中医肛肠科

出　　处：《临床外科杂志》2024年第5期517-520,共4页Journal of Clinical Surgery

摘　　要：目的探讨肛周脓肿切开引流术后发生肛瘘的危险因素,建立个体化预测列线图模型。方法2020年5月~2023年1月期间陕西中医药大学附属医院诊治的肛周脓肿病人224例,均行切开引流术治疗。根据术后3个月内是否发生肛瘘分为未发生肛瘘组(169例)和发生肛瘘组(55例)。采用单因素和多因素Logistic回归分析肛周脓肿切开引流术后发生肛瘘的影响因素,采用独立危险因素构建预测肛周脓肿切开引流术后发生肛瘘的列线图风险模型,并对模型进行一致性和区分度的验证。结果发生肛瘘组男性、有糖尿病史、深部脓肿、致病菌肠道来源、有脓肿病史病人比例高于未发生肛瘘组,差异有统计学意义(P<0.05)。男性、糖尿病、深部脓肿、致病菌肠道来源、有脓肿病史是肛周脓肿切开引流术后发生肛瘘的独立危险因素(P<0.05)。列线图模型理想曲线与校正曲线的拟合较好,表明实测值与预测值基本一致。受试者工作特征(ROC)曲线下面积为0.946(95%CI=0.914~0.979),表明该列线图模型有良好的预测区分度。结论影响肛周脓肿切开引流术后发生肛瘘的独立危险因素包括男性、糖尿病、深部脓肿、致病菌肠道来源、有脓肿病史,相关列线图模型的构建可一定程度指导临床筛查高危人群。Objective To explore the risk factors of anal fistula after incision and drainage surgery for perianal abscess,and establish an individualized predictive nomogram model.Methods A retrospective analysis was conducted on the clinical data of 224 patients with perianal abscess who underwent incision and drainage surgery in Affiliated Hospital of Shanxi University of Chinese Medicine from May 2020 to January 2023,according to whether anal fistula occurred within 3 months after surgery,there were 169 cases in the non anal fistula group and 55 cases in the anal fistula group.Single factor method and multivariate Logistic regression analysis were applied to analyze the influencing factors of anal fistula after incision and drainage of perianal abscess,a nomogram risk model was constructed using independent risk factors to predict the occurrence of anal fistula after incision and drainage of perianal abscess,and the consistency and differentiation of the model were verified.Results The proportions of male,diabetes,deep abscesses,intestinal origin of pathogenic bacteria,and abscesses in anal fistula group were higher than those in non anal fistula group(P<0.05).Male,diabetes,deep abscess,intestinal origin of pathogenic bacteria,and history of abscess were independent risk factors for anal fistula after incision and drainage of perianal abscess(P<0.05).The ideal curve of the nomogram model fitted well with the correction curve,indicated that the measured values were basically consistent with the predicted values.The area under the receiver operating characteristic(ROC)curve was 0.946(95%CI=0.914-0.979),indicated that the column plot model has good predictive discrimination.Conclusion The independent risk factors for anal fistula after incision and drainage surgery of perianal abscess include male,diabetes,deep abscess,intestinal origin of pathogenic bacteria,and history of abscess.The construction of related nomogram model can guide clinical screening of high-risk groups to a certain extent.

关 键 词：肛周脓肿 切开引流术 肛瘘 独立危险因素 列线图 

分 类 号：R657.15[医药卫生—外科学]