隐睾症患儿腹腔镜下手术时机的影响因素分析  

Analysis of factors influencing the timing of laparoscopic operation in children with cryptorchidism

作　　者：林海伟 刘海阳 刘成良 Lin Haiwei;Liu Haiyang;Liu Chengliang(Department of Pediatric Surgery,Linyi Central Hospital,Linyi 276400,Shandong Province,China)

机构地区：[1]临沂市中心医院小儿外科,临沂276400

出　　处：《中国基层医药》2024年第6期846-852,共7页Chinese Journal of Primary Medicine and Pharmacy

基　　金：山东省医药卫生科技发展计划(2018WS391)。

摘　　要：目的探讨隐睾症患儿腹腔镜下手术时机的影响因素。方法选择2020年1月至2023年6月临沂市中心医院接诊的隐睾症患儿150例的临床资料进行回顾性分析。以全部接受手术患儿的年龄中位数作为截断值分为低年龄组(n=75)和高年龄组(n=75)。纳入调查患儿手术时机的选择情况。对隐睾症患儿腹腔镜下手术时机进行单因素分析、多因素分析,并建立腹腔镜下手术时机的预测模型和预测效能分析。结果单因素分析显示,不同手术时机患儿的家庭收入水平、医疗费用支付形式、父母受教育程度、居住地属性差异均有统计学意义(χ^(2)=12.37、21.70、9.28、9.52、7.73,均P<0.05)。多因素分析显示,家庭收入水平偏低、医疗费用支付形式为自费、患儿父母受教育程度偏低、居住地为农村的隐睾症患儿为腹腔镜下手术时机发生延误的独立危险因素(OR=0.31、0.21、0.08、0.05、0.12、0.13、0.14、0.21、0.42,均P<0.05)。依据多因素分析结果构建列线图风险模型,一致性指数(C-index)为0.713。利用各独立影响因素、P值预测概率对手术时机情况进行预测,约登指数分别为22.67%、22.67%、25.33%、28.00%、22.67%、60.00%。结论接受隐睾症手术的患儿仍然会出现手术时机延后的情况,部分影响因素造成手术拖延,利用影响因素构建的预测模型具有良好的预测效能。Objective To investigate factors influencing the timing of laparoscopic surgery in children with cryptorchidism.Methods A retrospective analysis was conducted on data from 150 children with cryptorchidism treated at Linyi Central Hospital between January 2020 and June 2023.The children were grouped based on the median age of those who underwent surgery,with 75 children in the low age group and 75 children in the high age group.The timing of operation for included children was analyzed.Univariate and multivariate analyses were performed to assess laparoscopic operation timing in children with cryptorchidism.A predictive model for laparoscopic operation timing was constructed,and its prediction efficiency was analyzed.Results Univariate analysis revealed significant differences in family income level,medical expense payment method,parents'education level,and residence attributes among children who underwent surgery at different timings(χ^(2)=12.37,21.70,9.28,9.52,7.73,all P<0.05).Multivariate analysis demonstrated that independent risk factors for delayed laparoscopic surgery in children with cryptorchidism included low family income,self-payment of medical expenses,low parents'education level,and rural residence(OR=0.31,0.21,0.08,0.05,0.12,0.13,0.14,0.21,0.42,all P<0.05).Based on the results of the multivariate analysis,a nomogram risk model was constructed with a C-index of 0.713.This model utilized independent influencing factors and the prediction probability of the P-value to predict the timing of operation.The Yoden index values were 22.67%,22.67%,25.33%,28.00%,22.67%,and 60.00%,respectively.Conclusion Children with cryptorchidism still experience delayed surgery,which is attributed to several factors.The prediction model constructed using these influencing factors demonstrates good prediction efficiency.

关 键 词：隐睾 腹腔镜 泌尿生殖系统 家庭 手术时间 

分 类 号：R726.9[医药卫生—儿科]