临床胰瘘动态预测模型对腹腔镜胰十二指肠切除术中是否留置胰管支撑管的预测性能评估

Predictive performance of dynamic prediction model of clinically relevant pancreatic fistula in laparoscopic pancreaticoduodenectomy with or without pancreatic duct stent

目的研究临床胰瘘动态预测模型对腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)中是否放置胰管支撑管的预测性能。方法纳入2019年11月至2020年10月期间在随机对照实验中(注册号:ChiCTR1900026653)于四川大学华西医院接受LPD手术的66例患者,实时收集患者围术期资料,根据术中是否留置胰管支撑管进行分组,并按照模型公式输出概率预测值,分析其特异度、敏感度、准确率、预测值的区分度以及预测结果的稳定性。结果对放置支撑管的队列,该模型于术后第2、3和5天的模型界值点(预测值)的特异度、敏感度和准确率分别为92.0%、76.75和57.1%,50.0%、100%和66.7%以及88.8%、78.8%和61.3%,ROC曲线下面积分别为0.870、0.956和0.702,ROC界值点和模型界值点的预测结论Kappa值分别为0.308、0.582和0.744;在移除支撑管的患者中,该模型于术后第5天的模型界值点的特异度、敏感度和预测准确率分别为66.7%、100%和72.0%,其术后第2、3和5天的ROC曲线下面积分别为0.304、0.821和0.958,后两时间点下ROC界值点和模型界值点的预测结论Kappa值分别为0.465和0.449。结论在LPD术中置胰管支撑管的患者中,临床胰瘘动态模型能够更准确的筛查临床胰瘘高危人群,并有更好的预测结果稳定性;对于未留置支撑管的患者而言,在灵活调整界值点的情况下,模型亦可在术后第3和5天较为准确地进行筛查。

Objective To study the predictability of dynamic prediction model of clinical pancreatic fistula in patients with or without pancreatic duct stent in laparoscopic pancreaticoduodenectomy(LPD).Methods A total of 66 patients who underwent LPD in West China Hospital of Sichuan University from November 2019 to October 2020 were enrolled in the randomized controlled trial(registration number:ChiCTR1900026653).The perioperative data of the patients were collected in real time.The patients were divided into groups according to whether the pancreatic duct support tube was retained during the operation,and the probability prediction value was output according to the model formula.The specificity,sensitivity,accuracy,discrimination,and stability of the prediction results were analyzed.Results For the group with pancreatic stent tubes,the specificity,sensitivity,and accuracy of the model at the model cutoff points on the postoperative day 2,3 and 5 were 92.0%,76.7%and 57.1%,50.0%,100%and 66.7%,and 88.8%,78.8%and 61.3%,respectively.The areas under the ROC curve were 0.870,0.956 and 0.702,respectively.The kappa values of the prediction result based on model cut-off point and cut-off point of ROC curve were 0.308,0.582 and 0.744,respectively.Whereas for those who without the stent tube,the specificity,sensitivity,and prediction accuracy of the model on the postoperative day 5 were 66.7%,100%and 72%,respectively.The area under curve at different time points were 0.304,0.821,and 0.958,respectively.The kappa values at the last two time points were 0.465 and 0.449,respectively.Conclusions For patients with pancreatic duct support during LPD operation,the dynamic model of clinical pancreatic fistula can more accurately screen high-risk groups of clinical pancreatic fistula,and has better stability of prediction results.For patients without supporting tube,in the case of flexible adjustment of the boundary point,the model can also be more accurate screening on the 3 rd and 5 th days after operation.