摘要
目的探究大学生急性阑尾炎病人行日间腹腔镜阑尾切除术的可行性,并构建其达成概率的列线图预测模型。方法采用前瞻性队列研究设计,纳入2023年12月至2024年12月收治的82例大学生急性阑尾炎病人。所有病人均接受腹腔镜阑尾切除术及中西医结合加速术后康复管理,按日间模式达成情况分组。通过多因素logistic回归筛选独立预测因子,构建列线图模型并实施三重验证(区分度-校准度-临床效用)。结果82例病人中46例(56.0%)达成日间手术模式,住院时间(41.37±6.33)h,术后30 d复查无严重并发症。达成该模式的独立影响因素为:C反应蛋白≤13.9mg/L(OR=1.100,95%CI:1.005~1.204,P<0.05),腹痛时间≤22 h(OR=1.160,95%CI:1.022~1.316,P<0.05),阑尾直径≤10 mm(OR=13.683,95%CI:1.671~112.073,P<0.05),未置引流管(OR=6.058,95%CI:1.066~34.428,P<0.05),术后疼痛视觉模拟评分法(VAS)评分≤2.5分(OR=10.493,95%CI:2.696~40.835,P<0.05);基于logistic回归分析筛选的上述5项独立预测因子构建列线图预测模型,该模型的曲线下面积为0.905(95%CI:0.845~0.966),校准曲线显示高度一致性,决策曲线证实显著临床净获益。结论大学生群体接受日间腹腔镜阑尾切除术模式是安全可行的,创建的列线图模型具有较好的预测能力,可协助早期识别符合条件的病人,及时采取干预措施提高该模式的达成率。
Objective To explore the feasibility of day-care laparoscopic appendectomy in college students with acute appendicitis and to develop a nomogram to predict the probability of achieving this model.Methods A prospective cohort study design was adopted,and 82 college students with acute appendicitis admitted from December 2023 to December 2024 were included.All patients underwent laparoscopic appendectomy and integrated traditional Chinese and Western medicine management of enhanced recovery after surgery(ERAS).They were grouped according to the achievement of the day surgery model.Independent predictors were screened by multivariate logistic regression,and a nomogram was constructed and validated through a triple validation(discriminationcalibration-clinical utility).Results Among the 82 patients,46(56.0%)cases achieved the day surgery model.The hospital stay was 41.37±6.33 hours,and no serious complications were observed during the 30-day postoperative follow-up.The independent influencing factors for achieving this model were C-reactive protein≤13.9 mg/L(OR=1.100,95%CI:1.005-1.204,P<0.05),abdominal pain duration≤22 hours(OR=1.160,95%CI:1.022-1.316,P<0.05),appendiceal diameter≤10 mm(OR=13.683,95%CI:1.671-112.073,P<0.05),no drainage tube placement(OR=6.058,95%CI:1.066-34.428,P<0.05),and postoperative visual analogue scale(VAS)score≤2.5 points(OR=10.493,95%CI:2.696-40.835,P<0.05).Based on the logistic regression analysis,these five independent predictive factors were selected to construct a nomogram.The area under the curve(AUC)of this nomogram was 0.905(95%CI:0.845-0.966).The calibration curve showed high consistency,and the decision curve confirmed significant clinical net benefit.Conclusion The day-care laparoscopic appendectomy model is safe and feasible for college students.The created nomogram has good predictive ability and can assist in early identification of eligible patients and timely intervention to improve the achievement rate of this model.
作者
赵文博
马二民
孙维义
张楠
Zhao Wenbo;Ma Ermin;Sun Weiyi;Zhang Nan(Department of Trauma Surgery,the First Affiliated Hospital of Henan University of Chinese Medicine,Henan Zhengzhou 450000,China)
出处
《腹部外科》
2026年第1期41-46,59,共7页
Journal of Abdominal Surgery
基金
河南省医学科技攻关项目(LHGJ2021025)
湖北陈孝平科技发展基金会专项基金(CXPJJH123003-012)。
