摘要
目的分析肛周脓肿患者术后复发形成肛瘘的影响因素,构建预测术后复发形成肛瘘的列线图模型并验证模型的预测效果。方法采取便利抽样法,选取2019年1月至2022年2月重庆市大足区人民医院收治的419例肛周脓肿患者,按照7∶3随机分为建模组(293例)与验证组(126例),术后随访3个月,根据是否复发形成肛瘘分为肛瘘组与非肛瘘组。采用单因素和多因素Logistic回归分析筛选肛周脓肿患者术后复发形成肛瘘的独立危险因素,然后利用R 3.6.3软件建立列线图模型。以验证组对模型进行外部验证,绘制受试者工作特征(ROC)曲线、校准曲线证实列线图模型的预测效能。结果术后3个月内有140例(33.41%)患者复发形成肛瘘,其中建模组96例(32.76%),验证组44例(34.92%)。Logistic回归模型显示,糖尿病史(OR=3.101,95%CI:1.620~5.935)、肥胖(OR=3.157,95%CI:1.707~5.587)、有脓肿病史(OR=4.120,95%CI:2.201~7.713)、深部肛周脓肿(OR=3.686,95%CI:1.988~6.833)、肠道来源致病菌(OR=3.140,95%CI:1.679~5.872)和单纯切开引流术(OR=2.284,95%CI:1.548~5.152)是肛周脓肿患者术后复发形成肛瘘的危险因素(均P<0.01)。利用以上6个风险预测指标构建列线图模型,其内部验证的ROC曲线下面积为0.829(95%CI:0.781~0.877)、H-L检验χ^(2)=7.203,P=0.515,外部验证的ROC曲线下面积为0.857(95%CI:0.787~0.927),H-L检验χ^(2)=5.079,P=0.477,校准曲线斜率均接近1,两组验证方式均提示模型预测效果与实际发生风险有良好一致性。结论肥胖、糖尿病史、深部肛周脓肿、肠道来源致病菌、脓肿病史、单纯切开引流术是影响肛周脓肿患者术后复发形成肛瘘的危险因素,基于以上6个因素构建的列线图具有良好的区分度和准确性,可为肛周脓肿患者术前治疗策略制定提供参考。
Objective To analyze the risk factors of postoperative recurrence leading to anal fistula in patients with perianal abscess,and to construct a nomogram model and verify the prediction effect of the model.Methods A total of 419 patients with perianal abscess admitted to the People’s Hospital of Dazu from January 2019 to February 2022 were selected by convenience sampling method,and randomly divided into modeling group(293 cases)and verification group(126 cases)according to the ratio of 7∶3.The patients were followed up for 3 months after operation,and divided into anal fistula group and nonanal fistula group according to whether anal fistula recurred.Univariate and multivariate Logistic regression analyses were used to identify the independent risk factors of postoperative recurrence leading to anal fistula in patients with perianal abscess,and then the R 3.6.3 software was used to establish a nomogram model based on independent risk factors.The validation group was used for external validation of the model.The receiver operating characteristics(ROC)curve and calibration curve were applied to verify the predictive performance of the nomogram model.Results 140 cases(33.41%)had recurrence and formed anal fistula within 3 months after operation,including 96 cases(32.76%)of the modeling group and 44 cases(34.92%)of the validation group.Logistic regression model showed that history of diabetes mellitus(OR=3.101,95%CI:1.620-5.935),obesity(OR=3.157,95%CI:1.707-5.587),history of abscess(OR=4.120,95%CI:2.201-7.713),deep perianal abscess(OR=3.686,95%CI:1.988-6.833),intestinal flora infection(OR=3.140,95%CI:1.679-5.872)and simple incision and drainage(OR=2.284,95%CI:1.548-5.152)were independent risk factors of postoperative recurrence leading to anal fistula in patients with perianal abscess(all P<0.01).A nomogram model was constructed based on the above factors,the area under curve(AUC)of the internal validation was 0.829(95%CI:0.781-0.877),H-L testχ^(2)=7.203,P=0.515,and AUC of the external validation was 0.857(95%CI:
作者
何燕玲
龚代平
He Yanling;Gong Daiping(Department of Anorectal Surgery,the People’s Hospital of Dazu,Chongqing 402360,China)
出处
《中华普通外科学文献（电子版）》
CAS
2023年第1期28-33,共6页
Chinese Archives of General Surgery(Electronic Edition)
关键词
肛周脓肿
肛瘘
风险因素
列线图
Perianal abscess
Anal fistula
Risk factors
Nomogram
