混合痔外剥内扎术后并发肛缘水肿的个体化列线图预测模型的建立和评价

Establishment and evaluation of a personalized column chart prediction model for anal edge edema following external excision and internal ligation surgery for mixed hemorrhoids

目的探讨混合痔患者行外剥内扎术后并发肛缘水肿的影响因素并构建个体化列线图预测模型。方法选择2023年1月—2024年2月在本院进行外剥内扎术治疗的202例混合痔患者为研究对象,根据患者是否并发肛缘水肿分为肛缘水肿组(62例)与无肛缘水肿组(140例)两组。分析两组患者的临床资料,对其进行单因素分析、ROC曲线分析及二元logistic回归分析,R语言软件4.0“rms”包构建个体化列线图预测模型,Bootstrap法自抽样1000次进行模型内部验证,经Hosmer-Lemeshow检验及校准曲线评估个体化列线图预测模型的拟合度及校准度,通过决策曲线评估个体化列线图预测模型的临床适用性。结果202例行外剥内扎术的混合痔患者中,有62例发生肛缘水肿(30.69%),其中33例为炎症性水肿(16.34%),29例为充血性水肿(14.36%);两组患者在年龄、BMI、环状混合痔、“V”形切口偏移、术后中药熏洗、术后排便异常、术后疼痛方面的比较,差异均具有统计学意义(P<0.05);年龄、BMI的AUC为0.676、0.659,最佳截断值为54岁、23.64 kg/m^(2);年龄、BMI、环状混合痔、“V”形切口偏移、术后中药熏洗、术后排便异常、术后疼痛是混合痔外剥内扎术后并发肛缘水肿的影响因素;基于二元logistic回归分析筛选出的影响因素构建混合痔外剥内扎术后并发肛缘水肿的个体化列线图预测模型,绘制ROC曲线表明,AUC为0.846,95%CI为0.788~0.893,提示该个体化列线图预测模型区分度较高;Hosmer-Lemeshow检验结果表明该个体化列线图预测模型拟合度较好(χ^(2)=4.182,P=0.840);混合痔外剥内扎术后并发肛缘水肿的个体化列线图预测模型C-index为0.846,95%CI为0.787~0.905,说明该个体化列线图预测模型校准度较高;决策曲线表明,当风险阈值>0.19时,该个体化列线图预测模型在预测混合痔外剥内扎术后并发肛缘水肿方面可以提供额外的临床净收益。结论混合痔外剥内扎术后并发肛缘水肿的个体化列线图预测模型对肛缘水肿的发生具有较好的预测价值,可以应用于临床推广。

Objective To explore the influencing factors of postoperative anal margin edema in patients with mixed hemorrhoids after external excision and internal ligation,and to construct a personalized line chart prediction model.Methods A total of 202 patients suffering from mixed hemorrhoids who underwent external excision and internal ligation surgery in our hospital from January 2023 to February 2024 were selected as the study subjects.According to the occurrence of anal edge edema they were divided into two groups of anal edge edema group(n=62)and no anal edge edema group(n=140).The clinical data of the two groups were analyzed,and univariate analysis,ROC curve analysis and binary logistic regression analysis were performed.The R language software 4.0“rms”package was used to construct an individualized column chart prediction model.The Bootstrap method was used to carried out self samples 1000 times for internal validation of the model.The fit and calibration of the personalized column chart prediction model were evaluated through the Hosmer Lemeshow test and calibration curve.The clinical applicability of the personalized column chart prediction model was evaluated through the decision curve.Results Among the 202 patients with mixed hemorrhoid who underwent external excision and internal ligation,62 cases(30.69%)experienced anal edge edema,of which 33 cases were inflammatory edema(16.34%)and 29 cases were congestive edema(14.36%).There were statistically significant differences in age,BMI,circular mixed hemorrhoids,V-shaped incision deviation,postoperative traditional Chinese medicine fumigation,postoperative abnormal bowel movements,and postoperative pain between the two groups(P<0.05).The AUC of age and BMI were 0.676 and 0.659,and the optimal cutoff value was 54 years old and 23.64 kg/m^(2).Age,BMI,circular mixed hemorrhoids,V-shaped incision deviation,postoperative traditional Chinese medicine fumigation and washing,postoperative abnormal bowel movements,and postoperative pain were the influencing factors of postoperative anal edge edema after external excision and internal ligation of mixed hemorrhoids.Based on binary logistic regression analysis,a personalized column chart prediction model for postoperative anal edge edema in mixed hemorrhoids was constructed by the screened out influencing factors,and the ROC curve was drawn,and the results indicated that the AUC was 0.846,and the 95%CI was 0.788~0.893,indicating that the individualized column chart prediction model had high discrimination.The results of the Hosmer-Lemeshow test indicated that the personalized column chart prediction model had a good fit(χ^(2)=4.182,P=0.840).The C-index of individualized column chart prediction model for anal margin edema after mixed hemorrhoid external excision and internal ligation was 0.846 and the 95%CI was 0.787~0.905,indicating a high calibration of the individualized column chart prediction model.The decision curve indicated that when the risk threshold was greater than 0.19,the personalized column chart prediction model could provide additional clinical net benefits in predicting postoperative anal edema after mixed hemorrhoid excision and ligation surgery.Conclusions The personalized column chart prediction model has good predictive value for the occurrence of anal edge edema after external excision and internal ligation surgery due to mixed hemorrhoid and can be applied to clinical promotion.