远端胰腺切除术后胰瘘的影响因素及预测模型的验证  

Influencing Factors of Pancreatic Fistula After Distal Pancreatectomy and Validation of Prediction Model

作　　者：陈泳松 陈海洋 刘希 Chen Yongsong;Chen Haiyang;Liu Xi(Department of Hepatobiliary and Pancreatic Surgery,Ziyang City Central Hospital,Ziyang,Shichuan 641300,China)

机构地区：[1]资阳市中心医院肝胆胰外科,四川资阳641300

出　　处：《四川医学》2025年第2期178-182,共5页Sichuan Medical Journal

摘　　要：目的 分析远端胰腺切除术(DP)后胰瘘(PF)的影响因素,构建并验证预测模型。方法 选取2021年1月至2024年2月于我院接受DP手术的患者187例,根据其术后是否出现PF将其分为发生组(23例)、未发生组(164例)。收集患者临床病理相关资料,采用单因素分析及多因素Logistics回归分析筛选DP后PF影响因素,构建风险预测模型,建立受试者工作曲线(ROC)评估预测模型精准度。回顾性收集2019年1月至2020年12月DP患者临床资料,将其代入预测模型,验证模型评估准确度。结果 与未发生组相比,发生组患者胰腺质地组织结构细腻、均匀占比更大,术前胰腺CT值<40 Hu占比更大,胰管直径<3 mm占比更大(P<0.05)。Logistic回归分析显示,胰腺质地、术前胰腺CT值、胰管直径是影响DP患者术后PF发生的因素(P<0.05)。预测模型Y=1.311×胰腺质地+1.001×术前胰腺CT值+1.215×胰管直径-3.922,Hosmer和Lemeshow检验P=0.550。预测模型预测敏感度为0.652、特异度为0.799、约登指数为0.451、曲线下面积为0.751。验证模型所得曲线下面积0.766,特异度0.687,敏感度0.776,SE=0.066,95%CI 0.636~0.895,联合曲线与验证曲线ROC面积差异无统计学意义(Z=0.168,P=0.867)。结论 胰腺质地、术前胰腺CT值、胰管直径是DP术后PF影响因素,基于上述因素构建的预测模型有一定临床参考价值。通过预测模型,可以在术前对患者进行风险分层,识别出高风险患者,并为其制定更加精细的手术计划和术后护理方案以实现对手术结果的改进。Objective To analyze influential factors of pancreatic fistula(PF)after distal pancreatectomy(DP),construct and validate prediction model.Methods From January 2021 to February 2024,total 187 patients who received DP surgery in our hospital were selected and divided into a developing group(n=23)and a non-developing group(n=164)according to whether PF occurred after surgery.Clinic pathological data of patients were collected,and influencing factors of PF after DP were screened by univariate analysis and multi-factor Logistics regression analysis.The risk prediction model was constructed,and the receiver operating curve(ROC)was established to evaluate the accuracy of the prediction model.Clinical data of DP patients from January 2019 to December 2020 were retrospectively collected and substituted into the prediction model to verify the accuracy of model evaluation.Results Compared with the non-occurrence group,the proportion of smooth and uniform pancreatic texture tissues in the occurrence group was larger,the proportion of preoperative CT value<40 Hu was larger,and the proportion of pancreatic duct diameter<3 mm was larger(P<0.05).Logistic regression analysis showed that the texture of pancreas,preoperative CT value of pancreas and diameter of pancreatic duct were factors affecting the occurrence of postoperative PF in DP patients(P<0.05).Prediction model Y=1.311×texture of pancreas+1.001×preoperative CT value of pancreas+1.215×diameter of pancreatic duct-3.922.Hosmer and Lemeshow test was that P=0.550.The prediction sensitivity of the model was 0.652,the specificity was 0.799,the Yoden index was 0.451,and the area under the curve was 0.751.The area under the curve obtained by the verified model was 0.766,the specificity was 0.687,the sensitivity was 0.776,SE=0.066,and 95%CI 0.636~0.895,and there was no significant difference between two ROC areas(Z=0.168,P=0.867).Conclusion The texture of pancreas,preoperative CT value of pancreas and diameter of pancreatic duct would be influencing factors of PF after DP.The

关 键 词：远端胰腺切除术 胰瘘 影响因素 列线图 预测模型 

分 类 号：R735.9[医药卫生—肿瘤]