腹腔镜治疗肝脏良恶性疾病术后腹腔感染预测模型的构建与评价

Construction and Evaluation of a Predictive Model for Postoperative Abdominal Infection After Laparoscopic Treatment of Benign and Malignant Diseases of the Liver

目的探讨腹腔镜治疗肝脏良恶性疾病术后腹腔感染的危险因素,建立列线图预测模型并验证。方法回顾性收集2017年4月至2022年4月内江市第二人民医院肝胆外科行腹腔镜治疗肝脏良恶性疾病的190例患者临床资料建立训练集,根据术后是否发生腹腔感染将所有患者分为感染组(n=30)和非感染组(n=160)。分析所有患者的一般资料、血液学指标、手术相关指标,通过单因素分析及多因素Logistic回归分析探索术后发生腹腔感染的独立危险因素,建立风险预测模型,采用ROC曲线评价模型的预测效能。收集2022年5月至2023年7月行腹腔镜治疗肝脏良恶性疾病的74例患者临床资料建立验证集,对列线图预测模型进行验证。结果190例经腹腔镜治疗的肝脏良恶性疾病患者术后共有30例发生腹腔感染,其中包括肝囊肿4例、肝血管瘤4例、肝脏局灶性结节增生1例、原发性肝癌21例。多因素Logistic回归分析显示,白蛋白、引流管放置时间、术中出血量是腹腔镜治疗肝脏良恶性疾病术后腹腔感染的独立危险因素(均P<0.05),以上述3个独立危险因素为基础构建风险预测模型。绘制ROC曲线,结果显示训练集ROC曲线下面积为0.876(95%CI 0.822~0.930),约登指数为0.644,敏感度为0.800,特异度为0.844,验证集ROC曲线下面积为0.950(95%CI 0.883~1.000),表明该模型的预测效能较好。结论以白蛋白、血浆引流管放置时间、术中出血量为基础构建的预测模型具有良好的预测效能,对尽早地识别腹腔感染高风险患者具有较好的参考价值。

Objective To explore the risk factors of postoperative abdominal infection after laparoscopic treatment of benign and malignant diseases of the liver,and to establish a prediction model of column line diagram and validate it.Methods The clinical data of 190 patients who underwent laparoscopic treatment of benign and malignant diseases of the liver in the department of hepatobiliary surgery,the Second People s Hospital of Neijiang,were retrospectively collected from April 2017 to April 2022 to establish a training set,and all patients were categorized into an infected group(n=30)and a non-infected group(n=160)according to whether or not they developed abdominal infection in the postoperative period.The general data,hematological indexes,and surgery-related indexes of all patients were analyzed,and the independent risk factors for postoperative complications of infection were explored by univariate analysis and multifactorial logistic regression analysis to establish a risk prediction model,and the predictive efficacy of the model was evaluated by ROC curves.In addition,the clinical data of 74 patients who underwent laparoscopic treatment for benign and malignant diseases of the liver from May 2022 to July 2023 were collected to establish a validation set.The validation of the column-line graph prediction model was performed.Results A total of 30 postoperative abdominal infections occurred in 190 patients with benign and malignant diseases of the liver treated by laparoscopy,including 4 cases of hepatic cysts,4 cases of hepatic hemangiomas,1 case of focal nodular hyperplasia of the liver,and 21 cases of primary hepatocellular carcinoma.Multifactorial logistic regression analysis showed that albumin,drain placement time,and intraoperative bleeding were independent risk factors for postoperative abdominal infection after laparoscopic treatment of benign and malignant diseases of the liver(P<0.05),and a risk prediction model was constructed on the basis of the above three independent risk factors.The ROC curves were plotted,and the results showed that the area under the ROC curve for the training set was 0.876(95%CI 0.822~0.930),the Youden index was 0.644,the sensitivity was 0.800,and the specificity was 0.844,and the area under the ROC curve for the validation set was 0.950(95%CI 0.883~1.000),which indicated that the predictive efficacy of the model was good.Conclusion The prediction model based on albumin,plasma drain placement time,and intraoperative bleeding volume has good predictive efficacy,and is of good reference value for early identification of patients at high risk of abdominal infection.