摘要
目的研究胰十二指肠切除术(pancreaticoduodenectomy,PD)术后腹腔感染的危险因素并建立列线图预测模型,评估该模型的区分能力及一致性。方法选取2021年1月至2024年1月昆明医科大学第二附属医院收治的299例PD病人为研究对象,并收集其临床资料。通过单因素及多因素分析,筛选出差异具有统计学意义的独立危险因素,以此为基础构建腹腔感染风险列线图预测模型。采用受试者操作特征曲线及校准曲线评估检验列线图模型,最后进行决策曲线分析并评价其临床适用性。结果对299例样本进行统计分析,腹腔感染发生率为21.7%(65/299)。单因素和多因素分析结果显示:术后出血(OR=6.203,95%CI:1.273~30.228,P=0.024),胰瘘(OR=22.412,95%CI:7.080~70.941,P<0.001),腹腔积液(OR=12.057,95%CI:4.375~33.233,P<0.001),肺部感染(OR=15.592,95%CI:5.448~46.355,P<0.001),术后第3天C反应蛋白(OR:1.017,95%CI:1.007~1.028,P=0.001)是PD术后发生腹腔感染的独立危险因素,通过上述5个独立危险因素构建列线图预测模型。计算该模型受试者操作特征曲线下面积为0.938(95%CI:0.902~0.975),C指数为0.938,具有良好的区分度。模型经内部验证,Hosmer-Lemeshow拟合优度显示模型预测结果与实际观察结果之间基本吻合,绘制的决策分析曲线也表明了较高的临床价值。结论腹腔积液、肺部感染、胰瘘、术后第3天C反应蛋白、术后出血是PD术后腹腔感染的危险因素,所构建的预测模型可以较好地预测PD术后腹腔感染的发生风险。临床上应针对以上危险因素制定针对性干预措施,以减少腹腔感染发生风险。
Objective To explore the risk factors for intra-abdominal infections(IAI)after pancreaticoduodenectomy(PD)and to construct a nomogram to predict risk factors,followed by validations for its distinguishing ability and consistency.Methods A total of 299 patients treated with PD in the Second Affiliated Hospital of Kunming Medical University from January 2021 to January 2024 were selected for the study,and their clinical data were collected.Independent risk factors with statistical significance were screened through univariate and multivariate analyses,and a nomogram to predict the risk of IAI after PD was then created.Receiver operating characteristic and calibration curves were plotted to assess the performance of the nomogram.Its clinical applicability was finally assessed via the decision curve analysis.Results The incidence of IAI among 299 patients treated with PD was 21.7%(65/299).Univariate and multivariate analyses showed that postoperative bleeding(OR:6.203,95%CI:1.273-30.228,P=0.024),pancreatic fistula(OR=22.412,95%CI:7.080-70.941,P<0.001),abdominal effusion(OR=12.057,95%CI:4.375-33.233,P<0.001),lung infection(OR=15.592,95%CI:5.448-46.355,P<0.001),and C-reactive protein on day 3 postoperatively(OR=1.017,95%CI:1.007-1.028,P=0.001)were independent risk factors for IAI after PD.A nomogram involving the five risk factors was created,with an area under the curve of 0.938(95%CI:0.902-0.975).The C index of the nomogram was 0.938,suggesting a good discriminatory degree.The nomogram was internally validated,and the Hosmer-Lemeshow goodness of fit showed a good consistency with the actual observed results.also demonstrated a high clinical value.Conclusion Abdominal fluid,lung infection,pancreatic fistula,C-reactive protein on the third day after surgery,and postoperative bleeding are risk factors for IAI after PD.The constructed nomogram can better predict the risk of IAI after PD.Clinically,targeted interventions should be developed for the above risk factors to reduce the risk of IAI after PD.
作者
梁吉
魏晓平
董赟芳
胡知雄
高存彬
Liang Ji;Wei Xiaoping;Dong Yunfang;Hu Zhixiong;Gao Cunbin(Department of Hepatobiliary Surgery,The Second Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650000,China;Department of General Surgery,The Central Hospital of Xiangtan,Hunan Xiangtan 411100,China;Department of General Surgery,The Second People's Hospital of Baoshan City,Yunnan Baoshan 678000,China)
出处
《腹部外科》
2025年第4期279-285,共7页
Journal of Abdominal Surgery
基金
云南省科技计划项目(202201AY070001-116)
云南省科技计划项目(202301AY070001-261)。
关键词
胰十二指肠切除术
腹腔感染
危险因素
列线图
预测模型
Pancreaticoduodenectomy
Intra-abdominal infections
Risk factors
Nomogram
Prediction model
