腹腔镜经腹腹膜前疝修补术后复发的危险因素分析及风险模型的建立

Risk factors and risk model of recurrence after laparoscopic TAPP inguinal hernia repair

目的分析腹腔镜经腹腹膜前疝修补术(TAPP)术后复发的危险因素,并建立风险预测模型。方法回顾性分析2018年3月至2020年7月铜陵市人民医院及安庆市立医院行TAPP诊治的230例腹股沟疝患者的临床资料,单因素分析和Logistic多因素回归分析筛选经TAPP腹股沟疝修补术后复发的危险因素,以构建风险预测模型,并对模型进行验证。结果操作TAPP的例数(OR=3.337,95%CI:1.357〜8.401)、术中出血量>10 ml(OR=2.925,95%CI:1.027〜8.328)、手术时间>2 h(OR=2.492,95%CI:0.885〜7.014)、疝囊最大直径>5 cm(OR=2.675,95%CI:1.018〜7.031)、嵌顿疝(OR=7.329,95%CI:2.162〜24.56)是经TAPP腹股沟疝修补术后复发的独立危险因素,基于五项独立危险因素构建预测术后复发的风险列线图模型,并验证模型的预测准确度,实际值比较接近预测值,一致性指数C-index为0.833(95%CI:0.814〜0.851),表明该模型预测精准度较好。结论操作TAPP的例数、术中出血量>10 ml、手术时间>2 h、疝囊最大直径>5 cm及嵌顿疝是经TAPP腹股沟疝修补术后复发的独立危险因素,其建立的风险预测模型精准度较高,可以指导医务人员分析患者术后复发的风险程度,具有较高的临床应用价值。

Objective To analyze the risk factors of recurrence after laparoscopic trans-abdominal preperitoneal(TAPP)inguinal hernia repair and establish a risk prediction model.Methods The clinical data of 230 patients with inguinal hernia treated by TAPP in People's Hospital of Tongling and Anqing Municipal Hospital from March 2018 to July 2020 were retrospectively analyzed.Univariate analysis and Logistic multivariate regression analysis were used to screen the risk factors for recurrence after TAPP inguinal hernia repair,so as to build a risk prediction model and verify the model.Results Number of cases of operating TAPP(OR=3.337,95%CI:1.357-8.401),intraoperative blood loss>10 ml(OR=2.925,95%CI:1.027-8.328),operation time>2 h(OR=2.675,95%CI:1.018-7.031),the maximum diameter of hernia sac>5 cm(OR=2.675,95%CI:1.018-7.031)and incarcerated hernia(OR=7.329,95%CI:2.162-24.56)were independent risk factors for recurrence after TAPP inguinal hernia repair.Based on five independent risk factors,a risk nomogram model was established to predict postoperative recurrence,and the prediction accuracy of the model was verified.The actual value was close to the predicted value.The consistency index C-index was 0.833(95%CI:0.814-0.851),indicating that the prediction accuracy of the model is good.Conclusion Number of cases of operating TAPP,intraoperative blood loss>10 ml,operation time>2 h,the maximum diameter of hernia sac>5 cm and incarcerated hernia are independent risk factors for recurrence after TAPP inguinal hernia repair.The established risk prediction model has high accuracy,which can guide medical staff to analyze the risk degree of postoperative recurrence of patients,and has high clinical application value.