Development and validation of a nomogram prediction model for the risk of parastomal hernia

Background Parastomal hernia is one of the potential complications after enterostomy.There is currently no early risk assessment tool for parastomal hernia.Methods The current investigation was conducted using retrospective studies.A total of 302 cases were used develop and internally to validate a nomogram prediction model,and 67 cases were used for external validation.Independent risk factors for parastomal hernia after permanent sigmoid colostomy were assessed via univariate analysis and binary logistic regression analysis.The nomogram prediction model was established based on independent risk factors.Results Body mass index,serum albumin,age,sex,and stoma diameter were independent risk factors for parastomal hernia.The areas under the receiver operating characteristic curves were 0.909 in the development group and 0.801 in the validation group.The Hosmer-Lemeshow test(P>0.05)and calibration curves indicated good consistency between actual observations and predicted probabilities.Conclusions A nomogram prediction model was constructed and validated based on risk factors for parastomal hernia.The nomogram could be generalized to patients undergoing surgery for stoma by specialized surgeons to provide relevant references for stoma patients.

1例复杂的A3型甲状旁腺腺瘤功能亢进的手术治疗

甲状旁腺(parathyroid glands, PGs)是位于甲状腺后方的小结节内分泌器官,分泌甲状旁腺激素。甲状旁腺激素是参与血钙、血磷稳态的主要激素。朱精强将甲状旁腺分为A1、A2、A3,B1、B2、B3六个亚型,A1型为甲状旁腺与甲状腺表面相贴;A2型为甲状旁腺部分或完全嵌入甲状腺内而位于甲状腺固有被膜外;A3型为甲状旁腺完全位于甲状腺内;B1型为甲状腺周围型;B2型为甲状旁腺位于胸腺内;B3型为胸腺或纵隔的血管供血者。当甲状旁腺激素释放过多时会导致原发性甲状旁腺功能亢进症,而甲状旁腺切除是唯一的治疗办法。血清钙的增加是甲状旁腺功能亢进的生化标志,它主要好发于女性,男女比例为1:3~4,甲状旁腺功能亢进的病因包括单腺瘤(85%)、双腺瘤(2%~12%)、多腺瘤(5%~15%)和罕见的甲状旁腺癌(<1%)。甲状旁腺腺瘤导致的甲状旁腺功能亢进,术前需要结合甲状腺超声检查、甲状旁腺核素显像等综合判断甲状旁腺腺瘤的位置,从而达到手术治愈的目的。