Li Jiawen,Li Ying,Niu Wenyuan,et al.Risk factors related to anastomotic leakage after operation for type Ⅲ congenital esophageal atresia and risk modeling[J].Journal of Clinical Pediatric Surgery,2023,22(04):329-334.[doi:10.3760/cma.j.cn101785-202212008-006]
Ⅲ型先天性食管闭锁手术后吻合口漏的危险因素分析及风险模型建立
- Title:
- Risk factors related to anastomotic leakage after operation for type Ⅲ congenital esophageal atresia and risk modeling
- Keywords:
- Esophageal Atresia; Surgical Procedures; Operative; Postoperative Complications; Anastomotic Leak; Risk Factors
- 摘要:
- 目的 探讨Ⅲ型先天性食管闭锁手术后吻合口漏的危险因素并建立风险模型,为拟定对应预防措施提供理论依据。方法 回顾性分析2017年1月至2022年12月于山西省儿童医院(山西省妇幼保健院)确诊并经手术治疗的135例Ⅲ型先天性食管闭锁患儿临床资料,依据手术后是否存在吻合口漏将患儿分为两组:吻合口漏组(n=28)、非吻合口漏组(n=107);采取单因素分析及二元Logistic回归分析筛选出独立危险因素,建立风险模型并制作列线图,使用受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)和bootstrap法对Logistic回归模型进行评价及验证评估。结果 吻合口漏组与非吻合口漏组在性别、胎龄、手术日龄、手术类型、手术时间、术后吻合口狭窄以及术后合并肺部感染上比较,差异无统计学意义(P＞0.05);而体重、诊断分型、合并心血管畸形、使用呼吸机时间及低蛋白血症方面差异有统计学意义(P＜0.05)。诊断分型为ⅢA型(OR=0.173,95%CI:0.061~0.495)、存在低蛋白血症(OR=5.162,95%CI:1.554~17.152)、使用呼吸机时间≥5 d(OR=3.910,95%CI:1.490~10.260))是Ⅲ型先天性食管闭锁患儿手术后吻合口漏的独立危险因素(P＜0.05)。构建Logistic回归模型为:P=eLogit(P)/[1+eLogit(P)],回归方程Logit(P)=低蛋白血症×1.641-诊断分型×1.752+使用呼吸机时间×1.364-0.768,该模型的ROC曲线下面积为0.826,校准曲线平均绝对误差为0.035。结论 Ⅲ型先天性食管闭锁患儿手术后吻合口漏的独立危险因素为分型为ⅢA型、存在低蛋白血症以及使用呼吸机时间≥5 d。本研究风险模型对Ⅲ型先天性食管闭锁手术后是否发生吻合口漏有较高的区分度,预测能力良好,预测概率与实际概率一致性良好。
- Abstract:
- Objective To explore the risk factors related to anastomotic leakage after type Ⅲ congenital esophageal atresia (CEA) surgery and construct a risk model to provide theoretical rationales for formulating the corresponding preventive measures.Methods Retrospective analysis was performed for clinical data of 135 children with type Ⅲ CEA operated from January 2017 to December 2022.Based upon the presence or absence of anastomotic leakage after surgery,they were assigned into two groups of anastomotic leakage (n=28) and non-anastomotic leakage (n=107).Univariate and binary Logistic regression analyses were employed for screening out independent risk factors.Risk model was established and nomogram constructed.Receiver operating characteristic (ROC) curve and bootstrap method were utilized for evaluating the Logistic regression model.Results Diagnostic typing,hypoproteinemia and duration of ventilator use were identified as independent risk factors for anastomotic leakage.Logistic multivariate regression equation was further established.Area AUC=0.826 under the ROC curve of the model indicated that the risk model had a high degree of differentiation and an excellent capacity of predicting whether or not anastomotic leakage occurred after type Ⅲ CEA surgery.The average absolute error of calibration curve was 0.035.It hinted that the predicted probability of anastomotic leakage after type Ⅲ CEA surgery was in an excellent agreement with actual probability.Conclusion Through the above risk model,clinicians may predict the probability of anastomotic leakage after type Ⅲ CEA surgery.Conducive to identifying high-risk groups,it is of vital importance for improving clinical and nursing processes after surgery.
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备注/Memo
收稿日期:2022-12-2。
通讯作者:李颖,Email:1137545396@qq.com