后腹腔镜下输尿管切开取石术后尿路感染预测模型的构建

Construction predictive model of urinary tract infection after retroperitoneal laparoscopic ureterolithotomy

目的明确后腹腔镜下输尿管切开取石术后尿路感染相关风险因素,构建列线图模型进行风险预测。方法回顾性分析我院泌尿外科2016年5月至2018年12月接受后腹腔镜下输尿管切开取石术的患者资料,使用SPSS、R3.5.1软件对数据进行处理。结果共210例患者符合纳入标准,其中男性118例(56.2%),女性92例(43.8%),中位年龄50岁。术后发生泌尿系感染者30例(14.0%),无尿脓毒血症、感染性休克等严重并发症发生。多因素Logistic回归分析提示结石嵌顿时间,肾积水程度和是否合并糖尿病是术后发生感染的独立危险因素。将上述因素构建列线图预测模型后其C-index为0.839(95%CI=0.752,0.926),校正曲线显示模型符合度良好。结论结石嵌顿时间,肾积水程度和是否合并糖尿病是后腹腔镜下输尿管切开取石术后泌尿系感染的独立危险因素,结合上述因素构建的列线图可以作为泌尿外科医师的参考,以便临床医师早期、准确的进行干预,避免疾病的进展。

Objective To identify the risk factors of urinary tract in fection after retroperitoneal laparoscopic ureterolithotomy and to construct a nomogram for risk prediction.Methods The data of patients undergoing retroperitoneal laparoscopic ureterolithotomy in our hospital from May 2016 to December 2018 were analyzed retrospectively,and the information was processed by SPSS and R 3.5.1 software.Results 210 patients including 118 males(56.2%)and 92 females(43.8%)met the inclusion criteria,and the median age was 50 years.There were 30 cases(14%)of urinary infection after operation,no serious complications such as urinary sepsis and septic shock occurred.Logistic regression analysis suggested that time of stone embedding,degree of hydronephrosis and whether diabetes mellitus were independent risk factors for postoperative infection.After constructing the nomogram,the C-index was 0.839(95%CI=0.752,0.926),and the calibration curve for the probability of infection showed that the nomogram-based predictions were in good agreement with actual observations.Conclusion Time of stone embedding,degree of hydronephrosis and whether diabetes mellitus were independent risk factors for urinary infection after retroperitoneal laparoscopic ureterolithotomy,and the nomogram constructed by combined with the above factors can help to predict the risk of postoperative infection.