胰体尾切除术后胰漏风险预测模型的构建及验证  

Construction and validation of a risk prediction model for postoperative pancreatic fistula after distal pancreatectomy

作　　者：王雪梅 刘阳 刘子晗 李之华 WANG Xuemei;LIU Yang;LIU Zihan;LI Zhihua(Tianjin Medical University Cancer Institute&Hospital/National Clinical Research Center for Malignant Tumors/Tianjin Key Laboratory of Cancer Prevention and Treatment/Tianjin Cancer Clinical Medical Research Center,Tianjin 300060 China)

机构地区：[1]天津医科大学肿瘤医院,国家恶性肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市恶性肿瘤临床医学研究中心,天津300060

出　　处：《护理研究》2024年第17期3038-3044,共7页Chinese Nursing Research

基　　金：天津市医学重点学科(专科)建设项目,编号:TJYXZDXK⁃011A。

摘　　要：目的:探讨胰体尾切除术后病人发生术后胰漏的风险因素,并构建风险预测模型。方法:回顾性分析2020年3月—2022年9月在天津医科大学肿瘤医院胰腺肿瘤科行胰体尾切除术366例病人的临床资料,并按照3∶1的比例分为建模集(276例)和验证集(90例)。基于建模集分析术后胰漏的风险因素并绘制列线图,再利用建模集和验证集对模型的区分度、准确度和临床实用性进行分析。结果:建模集276例病人中61例发生术后胰漏,发生率为22.1%。多因素Logistic回归分析显示,男性、术前血红蛋白≥133.5 g/L、开腹手术、术中放疗、手术时间≥237.5 min、术后第1天腹腔引流液淀粉酶浓度(DFA1)≥2424.0 U/L是发生术后胰漏的影响因素,利用上述变量绘制列线图。建模集和验证集受试者工作特征曲线下面积分别为0.791[95%CI(0.725,0.858)]和0.755[95%CI(0.637,0.872)]。决策曲线分析显示,建模集和验证集中模型预测术后胰漏的最大净获益值阈值概率区间分别为7%~70%和6%~61%。结论:男性、术前血红蛋白≥133.5 g/L、开腹手术、术中放疗、手术时间≥237.5 min、DFA1≥2424.0 U/L为胰体尾切除术后病人发生术后胰漏的风险因素,基于上述变量构建的预测模型可为临床预防术后胰漏提供参考。Objective:To explore the risk factors of postoperative pancreatic fistula(POPF)after distal pancreatectomy(DP),and to establish a risk prediction model.Methods:Clinical data of 366 patients who underwent DP in the pancreatic cancer department,Tianjin Medical University Cancer Institute and Hospital from March 2020 to September 2022 were collected retrospectively,and were randomly assigned to a training group(n=276)and a verification group(n=90)according to the ratio of 3∶1.Firstly,based on the training group,the risk factors of POPF were screened through multivariate Logistic regression,and Nomogram was constructed.Then,the discrimination,calibration and clinical applicability of the model were tested by the training group and the verification group.Results:Among the 276 cases in the training group,61 had POPF,the incidence rate was 22.1%.The results of multivariate Logistic regression showed that male,preoperative haemoglobin≥133.5 g/L,open surgery,intraoperative radiotherapy,operation time≥237.5 min,drain fluid amylase on postoperative day 1(DFA1)≥2424.0 U/L were influencing factors for POPF after DP.According to the multivariate Logistic regression,the Nomogram prediction model was constructed.The AUC of ROC in the training group and the verification group were 0.791(95%CI 0.725⁃0.858)and 0.755(95%CI 0.637⁃0.872),respectively.The clinical decision curve showed that the threshold probability interval of the maximum net benefit value of the POPF predicted by the model in the training group and the verification group were 7%⁃70%and 6%⁃61%,respectively.Conclusions:Male,preoperative haemoglobin≥133.5 g/L,open surgery,intraoperative radiotherapy,operation time≥237.5 min,DFA1≥2424 U/L were risk factors for POPF after DP.The Nomogram constructed based on the above variables can provide reference for clinical prevention of POPF.

关 键 词：胰体尾切除术 术后胰漏 影响因素 预测模型 列线图 

分 类 号：R473.73[医药卫生—护理学]