外伤致尿道狭窄患者经会阴入路尿道重建术后复发的危险因素分析及其预测模型的构建  

Analysis of risk factors and construction of prediction modelfor recurrence in patients with traumatic urethral strictureafter urethral reconstruction through perineal approach

作　　者：武九龙 高利娟 WU Jiulong;GAO Lijuan(Puyang Traditional Chinese Medicine Hospital Stone Urology Department,Puyang 457000,China;Puyang Traditional Chinese Medicine HospitalInfection Control Department,Puyang 457000,China)

机构地区：[1]濮阳市中医医院结石泌尿外科,河南濮阳457000 [2]濮阳市中医医院感控科,河南濮阳457000

出　　处：《黑龙江医药科学》2024年第5期108-111,共4页Heilongjiang Medicine and Pharmacy

摘　　要：目的:探讨外伤致尿道狭窄患者经会阴入路尿道重建术后复发的危险因素分析及其预测模型的构建。方法:将2018年1月至2020年12月在濮阳市中医医院接受治疗的外伤所致尿道狭窄的患者211例的数据实施回顾性分析。外伤致尿道狭窄患者经会阴入路尿道重建术后复发的单因素、多因素分析。外伤致尿道狭窄患者经会阴入路尿道重建术后复发的预测模型构建和预测效能分析。结果:纳入研究的患者之中,共有36例复发,复发率为17.06%。单因素分析结果显示,术后复发情况不同的患者的罹患糖尿病情况、吸烟情况、术前行尿道扩张情况、狭窄尿道近端和耻骨相对位置情况以及术前血清总蛋白水平的数据差异有统计学意义(P<0.05)。Logistic多因素分析结果显示,罹患糖尿病情况、吸烟情况、术前行尿道扩张情况、狭窄尿道近端和耻骨相对位置情况以及术前血清总蛋白水平是外伤致尿道狭窄患者经会阴入路尿道重建术后复发的独立影响因素(P<0.05)。依据多因素分析所筛选出来的变量构建列线图风险模型,C-index为0.823。利用Bootstrap自抽样法进行内部验证,重复自抽样1000次,获得校准曲线,平均绝对误差为0.019。利用列线图模型对外伤致尿道狭窄患者经会阴入路尿道重建术后复发情况进行ROC曲线的预测,约登指数为67.00%。结论:外伤致尿道狭窄患者术后具有一定的复发风险,包括吸烟在内的若干因素是患者复发的独立影响因素;而基于各影响因素的预测模型能够较为良好的预测患者复发的结果。Objective:To analyze the risk factors of recurrent urethral stricture in patients with traumatic urethral stricture after urethral reconstruction through perineal approach and to establish a prediction model.Methods:The data of 211 patients with urethral stricture caused by trauma treated in our hospital from January 2018 to December 2020 were retrospectively analyzed.The recurrence of all patients was analyzed.Univariate and multifactorial analysis of patients with traumatic urethral stricture after urethral reconstruction by perineal approach.Construction of prediction model and analysis of prediction efficiency of recurrence in patients with traumatic urethral stricture after urethral reconstruction through perineal approach.Results:Of the patients included in the study,36 relapsed,with a recurrence rate of 17.06%.Of univariate analysis showed that the data of diabetes,smoking,urethral dilation before surgery,proximal stenosis urethra and relative position of pubis,and serum total protein level before surgery were statistically significant in patients with different recurrence conditions(P<0.05).Logistic multivariate analysis showed that diabetes mellitus,smoking,urethral dilation before surgery,proximal urethral stenosis and relative position of pubis,and preoperative serum total protein level were independent influencing factors for recurrence in patients with traumatic urethral stenosis after urethral reconstruction through perineal approach(P<0.05).The nomogram risk model was constructed based on the variables screened by multi-factor analysis,and the C-index was 0.823.Bootstrap self-sampling method was used for internal verification,and self-sampling was repeated 1000 times to obtain calibration curves with an average absolute error of 0.019.The ROC curve was used to predict the recurrence of patients with external injury urethral stricture after urethral reconstruction through perineal approach,and the Yoden index was 67.00%.Conclusion:Patients with urethral stricture caused by trauma have a certain risk

关 键 词：外伤 尿道狭窄 复发 尿道扩张 血清总蛋白 

分 类 号：R695[医药卫生—泌尿科学]