胆囊结石患者腹腔镜胆囊切除术后肠粘连的风险预测Nomogram模型构建与验证  

Construction and Validation of Nomogram Model to Predict the Risk of Intestinal Adhesion After Laparoscopic Cholecystectomy in Patients with Gallstones

作　　者：郭蕊馨 刘艳 张春艳 GUO Ruixin;LIU Yan;ZHANG Chunyan(Department of General Surgery,the Second People’s Hospital of Henan Province,Zhengzhou 451191,China;Quality Control Office,the Second People’s Hospital of Henan Province,Zhengzhou 451191,China)

机构地区：[1]河南省第二人民医院普外科,河南郑州451191 [2]河南省第二人民医院质控办,河南郑州451191

出　　处：《河南医学研究》2024年第14期2533-2538,共6页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190848)。

摘　　要：目的分析胆囊结石腹腔镜胆囊切除术后肠粘连的危险因素,构建风险预测列线图(Nomoagram)模型并进行验证。方法回顾性分析河南省第二人民医院2017年1月至2023年2月收治的429例胆囊结石腹腔镜胆囊切除术患者的临床资料,分为训练集(286例)与验证集(143例)。将训练集根据是否发生术后肠粘连分为发生组(41例)与未发生组(245例),logistic回归分析术后肠粘连的危险因素,R软件构建风险预测Nomogarm模型;基于该模型对训练集、验证集数据分别进行内部验证、受试者工作特征(ROC)曲线分析、决策曲线分析(DCA)验证其效能。结果训练集与验证集一般资料差异无统计学意义(P>0.05);经脐孔切口取胆(OR=5.546,95%CI:1.468~20.945)、施术者工龄(OR=0.590,95%CI:0.364~0.955)、使用预防肠粘连药物(OR=0.557,95%CI:0.332~0.932)、C反应蛋白(CRP)(OR=5.960,95%CI:1.693~20.975)均是术后肠粘连的影响因素(P<0.05);基于上述危险因素分析结果构建术后肠粘连的风险预测Nomogram模型,Bootstrap法验证发现C-index值为0.889、0.830,且校正曲线与标准曲线拟合度均良好;ROC曲线发现该模型对术后肠粘连的预测效能良好;DCA显示临床净收益理想。结论经脐孔切口取胆、施术者工龄、使用预防肠粘连药物、CRP均是胆囊结石腹腔镜胆囊切除术后肠粘连的影响因素,基于此构建的Nomogram模型值得推广应用。Objective To analyze the risk factors of intestinal adhesion after laparoscopic cholecystectomy for cholecystolithiasis,construct the risk prediction Nomogram model and verify it.Methods A retrospective analysis was made on the clinical data of 429 cases of cholecystolithiasis treated by laparoscopic cholecystectomy from January 2017 to February 23 in the Second People’s Hospital of Henan Province,which were divided into training set(286 cases)and validation set(143 cases).The training set was divided into an occurrence group(41 cases)and a non-occurrence group(245 cases)based on whether postoperative intestinal adhesions occur.Logistic regression analysis was performed on the risk factors of postoperative intestinal adhesions,and R software was used to construct a risk prediction Nomogarm model.Based on this model,internal validation,receiver operating characteristic(ROC)curve analysis,and decision curve analysis(DCA)were performed on the training set and validation set data to verify their effectiveness.Results There were no differences in general data between the training set and the validation set(P>0.05).Bile extraction through umbilical hole incision(OR=5.546,95%CI:1.468-20.945),length of service of the performer(OR=0.590,95%CI:0.364-0.955),using medication to prevent intestinal adhesions(OR=0.557,95%CI:0.332-0.932)and C-reaction protein(CRP)(OR=5.960,95%CI:1.693-20.975)were all influencing factors for postoperative intestinal adhesion(P<0.05).Based on the above risk factor analysis results,a Nomogram model for predicting the risk of postoperative intestinal adhesions was constructed.The Bootstrap method validation found that the C-index values were 0.889 and 0.830,respectively.And the calibration curve and standard curve had good fit.The ROC curve showed that the model had good predictive performance for postoperative intestinal adhesions.DCA showed ideal clinical net incomes.Conclusion Bile extraction through umbilical hole incision,the length of service of the operator,using medication to prevent intes

关 键 词：胆囊结石 腹腔镜 胆囊切除术 肠粘连 风险预测 

分 类 号：R657.4[医药卫生—外科学]