内镜下十二指肠乳头腺瘤切除术后出血原因分析及列线图模型构建

Analysis of causes of bleeding after endoscopic duodenal papillary adenoma resection and establishment of prediction model

目的分析并探讨内镜下十二指肠乳头腺瘤切除术后出血的原因,并构建列线图预测模型。方法回顾性分析2018年01月至2023年12月在我院行内镜下十二指肠乳头腺瘤切除术的患者共233例,根据术后是否发生出血分为出血组(n=31例)和未出血组(n=202例)。比较两组的临床资料,采用多因素logistic回归分析术后出血独立危险因素,并构建风险列线图预测模型,采用Bootstrap法重复抽样1000次展开内部验证。结果服用抗凝血药物(OR=9.063,95%CI:2.132~38.525)、病灶直径≥2 cm(OR=2.802,95%CI:1.073~7.321)、术中分片切除(OR=27.653,95%CI:3.055~619.174)、术后合并胰腺炎(OR=6.859,95%CI:1.930~24.377)是内镜下十二指肠乳头腺瘤切除术后出血的独立危险原因,(P<0.05)。根据Logistic回归分析结果构建风险预测列线图模型,通过Bootstrap法对样本重复抽样1000次开展内部验证,结果显示ROC曲线下的面积为0.850,95%CI为0.780~0.913,模型区分能力好。校准曲线显示列线图预测模型预测术后出血概率与实际术后出血概率具有较好的一致性,Hosmer-Lemeshow显示拟合优度良好(χ^(2)=3.3049,P=0.9138)。结论服用抗凝血药物、病灶直径≥2 cm、术中分片切除、术后合并胰腺炎是内镜下十二指肠乳头腺瘤切除术后出血独立危险因素,以此建立列线图预测模型,评估患者术后出血风险,为早期临床预防及干预提供决策依据。

Objective The causes of bleeding after endoscopic duodenal papilloma resection were analyzed and discussed,and the prediction model of nomogram was established.Methods A total of 233 patients who underwent endoscopic duodenal papilloma resection in our hospital from January 2018 to December 2023 were retrospectively analyzed,and they were divided into bleeding group(n=31 cases)and non-bleeding group(n=202 cases)according to whether postoperative bleeding occurred.The clinical data of the two groups were compared,the independent risk factors for postoperative bleeding were analyzed by multi-factor logistic regression,the risk nomogram prediction model was constructed,and the Bootstrap method was used for 1000 repeated samples to carry out internal verification.Results Anticoagulant drugs(OR=9.063,95%CI:2.132-38.525),lesion diameter≥2 cm(OR=2.802,95%CI:1.073-7.321),intraoperative fragment resection(OR=27.653,95%CI:3.055~619.174)and pancreatic complications(OR=6.859,95%CI:1.930~24.377)were independent risk factors for postoperative bleeding after endoscopic duodenal papilloma resection(P<0.05).A risk prediction nomogram model was constructed according to the Logistic regression analysis results.The samples were repeatedly sampled 1000 times through Bootstrap method for internal verification.The area under the ROC curve was 0.850,and the 95%CI was 0.780-0.913,indicating good differentiation ability of the model.Calibration curve analysis indicated that the prediction probability of postoperative bleeding predicted by the nomogram prediction model was in good agreement with the actual probability of postoperative bleeding,and Hosmer-Lemeshow showed good goodness of fit(2=3.3049,P=0.9138).Conclusion Taking anticoagulant drugs,lesion diameter≥2 cm,intraoperative segmentary resection,and postoperative combination of pancreas were independent risk factors for bleeding after endoscopic duodenal papilloma resection.A nomogram prediction model was established to help clinical assessment of postoperative bleeding risk in patients and improve decision-making basis for early prevention.