腹腔镜肾部分切除术后并发症预测模型的建立与分析

Establishment and analysis of a predictive model of complications after laparoscopic partial nephrectomy

目的分析影响腹腔镜肾部分切除术后发生并发症的因素,构建列线图预测模型并验证其准确性。方法回顾性分析2017年9月-2021年7月在中国科学技术大学附属第一医院进行腹腔镜肾部分切除术的300例患者的临床资料,对患者进行3个月的随访,根据患者术后是否出现并发症将其分为并发症组和无并发症组,分析影响腹腔镜肾部分切除术后并发症发生的危险因素,构建风险预测模型,并验证模型的区分度及准确性。结果本研究中48例(16.00%)患者在腹腔镜肾部分切除术后出现并发症;肿瘤最深处与肾集合系统或肾窦的距离(N值)、热缺血时间≥30 min、合并糖尿病、术中出血量>50 mL为影响腹腔镜肾部分切除术后并发症的独立危险因素(P<0.05);以此为基础构建预测腹腔镜肾部分切除术后并发症的列线图模型,该模型的H-L拟合度检验结果为χ2=6.527,P=0.413。ROC曲线下面积为0.953,敏感性为89.58%,特异性为90.08%,95%CI:0.92~0.97。结论N值、热缺血时间≥30 min、合并糖尿病、术中出血量>50 mL为影响腹腔镜肾部分切除术后并发症发生的独立危险因素,以此构建的列线图风险预测模型具有较高的区分度及准确性,可为临床早期干预腹腔镜肾部分切除术后并发症的发生提供依据。

Objective To explore factors affecting the complications after laparoscopic partial nephrectomy(RLPN),construct and analyze the nomogram prediction model.Methods Clinical data of 300 patients who underwent RLPN in our hospital during Sep.2017 and Jul.2021 were retrospectively analyzed.The patients were divided into complication group and non-complication group.Risk factors for complications were analyzed,a risk prediction model was constructed,and the specificity and accuracy of the model were verified.Results In this study,48 patients(16.00%)had complications.The distance between the deepest tumor and the renal collecting system or renal sinus(N value),warm ischemia time≥30 min,diabetes and intraoperative blood loss>50 mL were independent risk factors for complications(P<0.05).The H-L fit test result of the nomogram model showedχ2=6.527,P=0.413.The area under the receiver operating characteristic(ROC)curve was 0.953,sensitivity was 89.58%,specificity was 90.08%,and 95%CI was 0.92-0.97.Conclusion N value,warm ischemia time≥30 min,diabetes and intraoperative blood loss>50 mL are independent risk factors for complications after RLPN.The nomogram risk prediction model has high specificity and accuracy,which can provide reference for the intervention of complications after RLPN.