化脓性阑尾炎患者腹腔镜手术后发生肠瘘的危险因素及预测模型的建立

Risk factors and prediction model establishment of occurrence of intestinal fistula in patients with suppurative appendix after laparoscopic surgery

目的探讨化脓性阑尾炎患者腹腔镜手术后发生肠瘘的危险因素,并建立列线图预测模型。方法回顾性分析100例经腹腔镜手术治疗的化脓性阑尾炎患者的临床资料,根据术后是否发生肠瘘将患者分为肠瘘组(35例)和非肠瘘组(65例)。比较两组患者的临床资料,采用LASSO回归分析筛选自变量后进行多因素Logistic回归分析。根据多因素Logistic回归分析获得的危险因素建立列线图预测模型并进行内部验证。结果经腹腔镜手术治疗后,有35例(35.0%)化脓性阑尾炎患者发生肠瘘。肠瘘组的年龄≥35岁的患者比例、男性患者比例、体质指数≥24 kg/m^(2)的患者比例、合并肠梗阻的患者比例、有术后感染的患者比例及有Crohn病史的患者比例均高于非肠瘘组(均P<0.05)。多因素Logistic回归分析结果显示,体质指数≥24 kg/m^(2)、合并肠梗阻、有术后感染、有Crohn病史均为化脓性阑尾炎患者腹腔镜手术后发生肠瘘的危险因素(均P<0.05)。采用上述因素建立列线图预测模型,受试者工作特征曲线及校准曲线提示该模型具有较好的区分度和准确度。结论体质指数≥24 kg/m^(2)、合并肠梗阻、有术后感染、Crohn病史均为化脓性阑尾炎患者腹腔镜手术后发生肠瘘的独立危险因素。根据上述因素建立的列线图预测模型在评估患者术后肠瘘发生风险方面具有较高的准确度和区分度。

Objective To explore the risk factors for occurrence of intestinal fistula in patients with suppurative appendix after laparoscopic surgery,and to establish the nomogram prediction model.Methods The clinical data of 100 patients with suppurative appendix who underwent laparoscopic surgery for treatment were retrospectively analyzed,and they were assigned to intestinal fistula group(35 cases)or non-intestinal fistula group(65 cases)according to the presence of suffering from intestinal fistula.The clinical data were compared between patients of the two groups.The LASSO regression analysis was used for screening independent variables,and then the multivariate Logistic regression analysis was performed.According to the multivariate Logistic regression analysis,the risk factors were obtained to establish the nomogram prediction model,and then internal validation was conducted.Results After laparoscopic surgery for treatment,there were 35(35.0%)suppurative appendix patients suffering from intestinal fistula.The intestinal fistula group exhibited higher proportions of patients with age≥35 years old,male patients,patients with body mass index≥24 kg/m^(2),patients with concomitant intestinal obstruction,patients with postoperative infection,and patients with Crohn disease history as compared with the non-intestinal fistula group(all P<0.05).The results of the multivariate Logistic regression analysis revealed that body mass index≥24 kg/m^(2),concomitant intestinal obstruction,presence of postoperative infection,and presence of Crohn disease history were the risk factors for suffering from intestinal fistula in patients with suppurative appendix after laparoscopic surgery(all P<0.05).The nomogram prediction model was established by using aforementioned factors,and the receiver operating characteristic curve and calibration curve indicated that this model exerted favorable discrimination and accuracy.Conclusion Body mass index≥24 kg/m^(2),concomitant intestinal obstruction,presence of postoperative infection,and presence of Crohn disease history are the independent risk factors for occurrence of intestinal fistula in patients with suppurative appendix after laparoscopic surgery.The nomogram prediction model established based on aforesaid factors exerts relatively high accuracy and discrimination in evaluating the occurrence risk of intestinal fistula in patients after surgery.