摘要
目的探讨乙肝肝硬化门静脉高压症患者行脾切除术后腹腔积液危险因素,并建立预测脾切除术后腹腔积液的预测模型。方法回顾性收集2017年1月至2023年2月南方医科大学南方医院肝胆外科收治的行脾切除术的乙肝肝硬化门静脉高压症患者的临床资料。根据术后是否存在腹腔积液,将患者分为腹腔积液组(n=32)和无腹腔积液组(n=89)。采用SPSS 25.0软件进行术后腹腔积液的危险因素分析。基于多因素分析结果,采用R语言建立和评估术后腹腔积液列线图预测模型。结果单因素分析显示两组患者年龄、身体质量指数(BMI)、术前脾静脉直径、术前门静脉直径、术前腹腔积液、行贲周血管离断术、术中失血量、术后第1天、第5天白蛋白差异存在统计学意义(P<0.05)。多因素分析结果显示患者术前门静脉直径(OR=229.127,95%CI 9.348-5615.995)、术前存在腹腔积液(OR=3.331,95%CI 1.128-9.842)、行贲周血管离断术(OR=6.745,95%CI 1.334-34.093)是脾切除术后腹腔积液的独立危险因素。纳入独立危险因素变量构建乙肝肝硬化门静脉高压症脾切除术后腹腔积液的列线图模型。模型的Hosmer-Lemeshow拟合优度检验显示拟合程度良好(P=0.779);ROC曲线下面积AUC为0.852(95%CI 0.781-0.924)。临床决策曲线显示模型对术后腹水的预测具有明显临床效用。结论术前门静脉直径、术前存在腹腔积液、行贲周血管离断术是乙肝肝硬化门静脉高压症行脾切除术后腹腔积液的独立危险因素,在此基础上建立的列线图模型对脾切除术后腹腔积液有良好的预测能力。
Objective To explore the risk factors of ascites after splenectomy in patients with hepatitis B cirrhosis and portal hypertension,and to establish a predictive model that can predict ascites after splenectomy.Methods Clinical data of patients with portal hypertension due to hepatitis B cirrhosis,who underwent splenectomy in Nanfang Hospital of Southern Medical University from Jan.2017 to Feb.2023,were retrospectively collected.According to whether there was ascites after surgery,the patients were divided into the ascites group(32 cases)and the non-ascites group(89 cases).SPSS 25.0 software was used to analyze the risk factors of postoperative abdominal fluid accumulation.Based on the results of multiple factor analysis,a predictive model of nomogram was established and evaluated using R language.Results Univariate analysis showed that there were statistically significant differences in age,body mass index(BMI),preoperative splenic vein diameter,preoperative portal vein diameter,preoperative abdominal fluid accumulation,presence of pericardial devascularization,intraoperative blood loss,and albumin levels on the first and fifth day after surgery between the two groups of patients(P<0.05).The results of multivariate analysis showed that patients with a wide diameter of the anterior portal vein(OR=3.331,95%CI 1.128-9.842),the presence of abdominal fluid accumulation before surgery(OR=229.127,95%CI 9.348-5615.995),and history of pericardial devascularization(OR=6.745,95%CI 1.334-34.093)were independent risk factors for postoperative abdominal fluid accumulation after splenectomy.All the independent risk factors were included to construct a nomogram model of ascites after splenectomy for portal hypertension in patients with hepatitis B cirrhosis.The HosmerLimeshow goodness of fit test result of the model was P=0.779,indicating a good degree of fit.The AUC under the ROC curve was 0.852(95%CI 0.781-0.924).The clinical decision curve showed that the model had significant clinical utility in predicting postoperative ascit
作者
李芷西
黄少坚
贺卓
黄嘉明
张起帆
周杰
王恺
LI Zhixi;HUANG Shaojian;HE Zhuo;HUANG Jiaming;ZHANG Qifan;ZHOU Jie;WANG Kai(Department of Hepatobiliary Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)
出处
《肝胆胰外科杂志》
CAS
2023年第12期736-741,746,共7页
Journal of Hepatopancreatobiliary Surgery
基金
国家自然科学基金项目(82070642)
广东省基础与应用基础研究基金(2021A1515012485)。
