摘要
目的通过分析肝囊型包虫病手术患者胆漏风险发生的相关危险因素,建立个体化预测囊型包虫胆漏发生风险的列线图模型。方法回顾性分析2016年1月至2018年10月于青海大学附属医院手术治疗的203例囊型包虫患者临床资料,通过logistic回归筛选出囊型包虫手术患者胆漏发生风险的独立危险因素;根据独立危险因素,采用R软件建立囊型包虫胆漏发生风险的列线图预测模型,使用Bootstrap法进行模型验证,并应用受试者工作特征曲线(ROC)探索列线图模型对囊型包虫胆漏发生风险的预测效率。结果203例肝囊型包虫病手术患者发生胆漏54例,发生率为26.6%。碱性磷酸酶(ALP,OR=11.193,95%CI 5.066~24.731)、谷氨酰转移酶(GGT,OR=2.728,95%CI 1.246~5.975)、囊肿直径(OR=3.491,95%CI 1.550~7.861)、肝门部囊肿(OR=2.503,95%CI 1.176~5.329)是肝囊型包虫病患者术后发生胆漏的独立危险因素(均P<0.05)。列线图模型预测该病手术患者胆漏发生风险的一致性指数为0.835,曲线下面积(ROC)为0.823(95%CI 0.754~0.892)。结论ALP、GGT、囊肿直径、肝门部囊肿是囊型包虫胆漏发生的独立危险因素,列线图模型可更直观地评价该病手术患者胆漏发生的风险,有较高的临床应用价值。
Objective To analyze the risk factors for bile leakage in patients undergoing cystic echinococcosis surgery to establish a nomogram model to predict the risk of bile leakage.Methods The clinical data were retrospectively analyzed that 203 patients with cystic echinococcosis treated in Qinghai University Affiliated Hospital from January 2015 to October 2018.Logistic regression was used to screen out independent risk factors of biliary leakage in patients undergoing cystic hydatid surgery.Then the R software was used to establish a predictive nomogram model.Bootstrap method was used to validate the nomogram model and ROC curve was used to explore the predictive efficacy of the model in predicting the bile leakage.Results There were 54 cases of biliary leakage in 203 patients with cystic echinococcosis,the incidence was 26.1%.ALP(OR=11.193,95%CI 5.066-24.731),GGT(OR=2.728,95%CI 1.246-5.975),cyst diameter(OR=3.491,95%CI 1.550-7.861),hilar cyst(OR=2.503,95%CI 1.176-5.329)were all independent risk factors for biliary leakage of cystic echinococcosis.The consistency index was 0.835 for predicting PPC risk,and the area was 0.823(95%CI 0.754-0.892)under the curve for predicting the risk of cystic echinococcal bile leakage.Conclusions ALP,GGT,cyst diameter and hepatic hilar cyst are independent risk factors for cystic echinococcal bile leakage.Nomogram model can evaluate the risk of cystic echinococcal bile leakage more intuitively,with potentially high clinical application value.
作者
王展
胥瑾
王海久
周瀛
任利
任宾
张灵强
许晓磊
叶海雯
樊海宁
Wang Zhan;Xu Jin;Wang Haijiu;Zhou Ying;Ren Li;Ren Bin;Zhang Lingqiang;Xu Xiaolei;Ye Haiwen;Fan Haining(Department of Hepatobiliary and Pancreatic Surgery,Qinghai University Affiliated Hospital,Xining 810001,Qinghai Province,China;The Youth League Committee of Qinghai University,Xining 810016,Qinghai Province,China;Key Laboratory of Echinococcosis Research of Qinghai Province,Xining 810001,Qinghai Province,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2020年第4期241-246,共6页
Chinese Journal of Hepatobiliary Surgery
基金
国家重点研发计划(2017YFC0909900)
青海省包虫病临床医学研究中心项目(2017-SF-L2)。
关键词
包虫病
肝
外科术后
胆漏
预测
列线图
Echinococcosis
Liver
After surgery
Bile leakage
Prediction
Nomogram
