预测胰十二指肠切除术后切口疝发病风险列线图模型的建立

目的建立预测胰十二指肠切除（PD）术后发生切口疝的风险列线图模型，为切口疝的早期干预提供依据。 方法回顾性分析2009年1月至2017年1月于邯郸市中心医院行PD术的926患者的临床资料，随访发生切口疝的患者24例（切口疝组），未发生切口疝的按照1∶5的比例随机抽取120例为非切口疝组。分别使用单因素和Logistic回归多因素分析术后切口疝的独立危险因素，并建立相关列线图预测模型。 结果年龄≥60岁（OR=5.800，95% CI 1.530~21.984）、BMI≥24 kg/m²（OR=4.165，95% CI 1.187~14.613）、糖尿病（OR=5.321，95% CI 1.548~18.285）、呼吸系统疾病（OR=4.565，95% CI 1.225~17.007）、切口感染（OR=6.803，95% CI 1.573~29.419）及手术时间≥6 h（OR=6.934，95% CI 1.938~24.813）是PD术后发生切口疝的独立危险因素（P<0.05）。基于以上6项独立危险因素建立列线图模型，并对该模型进行验证，预测值同实测值基本一致，C-index 0.890（95% CI 0.854~0.926），说明本研究列线图模型具有良好的精准度和区分度。 结论年龄≥60岁、BMI≥24 kg/m²、糖尿病、呼吸系统疾病、切口感染及手术时间≥6 h是PD术后发生切口疝的独立危险因素，本研究建立的列线图预测模型具有良好的精准性和区分度，有利于临床筛查PD术后发生切口疝的高风险人群和制定针对性规避措施。

Establishment of a nomogram model to predict the risk of incisional hernia after pancreaticoduodenectomy

ObjectiveTo establish a nomogram model for predicting the risk in incisional hernia after pancreaticoduodenectomy (PD) to provide a basis for early intervention of incisional hernia. MethodsThe clinical data of 926 patients who underwent PD at Handan Central Hospital from January 2009 to January 2017 were retrospectively analyzed. 24 patients with incisional hernias (the incisional hernia group) were followed up, and 120 patients were randomly selected as having non-incisional hernia in a ratio of 1:5. Independent risk factors for postoperative incisional hernia were analyzed using univariate and logistic regression separately, and a relevant nomogram prediction model was established. ResultsAge≥60 years old (OR=5.800, 95% CI 1.530~21.984), BMI≥24 kg/m² (OR=4.165, 95% CI 1.187~14.613), diabetes (OR=5.321, 95% CI 1.548~18.285), respiratory disease (OR=4.565, 95% CI 1.225~17.007), wound infection (OR=6.803, 95% CI 1.573~29.419) and operation time≥6 h (OR=6.934, 95% CI 1.938~24.813) is an independent risk factor for incisional hernia after PD (P<0.05). Based on the above six independent risk factors, a nomogram model was established and verified. The predicted value is basically the same as the measured value. The C-index index is as high as 0.890 (95% CI 0.854~0.926), which shows the nomogram model of this study has good accuracy and differentiation. ConclusionAge ≥60 years, BMI ≥24 kg/m², diabetes, respiratory disease, incision infection and operation time ≥6 h are independent risk factors for incisional hernia after PD. The nomogram prediction model established in this study has good accuracy and differentiation, which is conducive to the clinical screening of people at high risk of incisional hernia after PD and the development of targeted avoidance measures.