Zhang Jinwei,Su Jun,Wu Shuihua,et al.Influencing factors for treatment failure within 30 days post-hydrocephalus surgery in children and developing a risk prediction model[J].Journal of Clinical Pediatric Surgery,2026,(03):249-255.[doi:10.3760/cma.j.cn101785-20251028-00022]
儿童脑积水术后30天内治疗失败影响因素分析及风险预测模型构建
- Title:
- Influencing factors for treatment failure within 30 days post-hydrocephalus surgery in children and developing a risk prediction model
- Keywords:
- Hydrocephalus; Ventriculostomy; Prognosis; Root Cause Analysis
- 摘要:
- 目的 评估儿童脑积水术后30天内治疗失败的危险因素,构建并验证临床可用的个体化风险预测模型。方法 回顾性纳入2016年7月至2025年9月湖南省儿童医院首次接受手术的儿童脑积水患儿326例,收集人口学、病因、影像学及围术期资料。以术后30天内治疗失败为结局,经单因素分析筛选候选变量后,采用多因素Logistic回归识别独立危险因素,同时纳入"手术方式×病因"交互项。基于显著变量构建列线图模型,采用受试者操作特征(receiver operating characteristic,ROC)曲线的曲线下面积(area under curve,AUC)、Hosmer-Lemeshow检验与校准曲线评估判别度与校准度,并以Bootstrap重采样(1000次)进行内部验证,辅以决策曲线分析(decision curve analysis,DCA)评价临床净获益。结果 总体术后30天治疗失败率为20.86%(68/326)。多因素Logistic回归分析结果显示:额-枕角比≥60%(OR=3.826,95%CI:2.154~6.798)、感染相关病因(OR=3.215,95%CI:1.732~5.976)、出血相关病因(OR=2.783,95%CI:1.462~5.297)及手术方式为内镜下第三脑室造瘘术(相对于脑室-腹腔分流术)(OR=2.517,95%CI:1.389~4.558)为脑积水术后30天内治疗失败的独立危险因素。交互分析提示:感染或出血相关亚组中,ETV早期失败风险分别为VPS的2.49倍与2.40倍;而先天/发育异常、囊肿、外伤、肿瘤等其他病因中,两术式失败风险差异无统计学意义(P＞0.05)。列线图模型AUC=0.831(95%CI:0.744~0.919),Hosmer-Lemeshow检验χ2=6.328、P=0.610,校准良好;DCA显示阈值概率8%~45%时具明显净获益。结论 病因类型、术式选择及术前脑室扩张程度是儿童脑积水术后30天治疗失败的关键因素;基于额-枕角比、病因与术式构建的列线图预测模型区分度与校准度良好。
- Abstract:
- Objective To identify the risk factors for treatment failure within 30 days after surgery in children with hydrocephalus and develop a clinically applicable individualized prediction model.Methods We retrospectively analyzed 326 children undergoing initial operation (VPS/ETV) from July 2016 to September 2025 at a tertiary center.Primary outcome was treatment failure within 30 days.Candidate variables were screened by univariate tests and entered into multivariable Logistic regression,including an interaction term between surgical procedure and etiology.A nomogram was constructed from significant predictors.Model performance was assessed by area under the ROC curve (AUC),calibration curve with Hosmer-Lemeshow test,1,000-bootstrap internal validation and decision curve analysis (DCA).Results The 30-day failure rate was 20.86%(68/326).Independent predictors included severe ventriculomegaly (FOHR ≥0.60;OR=3.826,95%CI:2.154-6.798),infection-related etiology (OR=3.215,95%CI:1.732-5.976),hemorrhage-related etiology (OR=2.783,95%CI:1.462-5.297) and ETV versus VPS (OR=2.517,95%CI:1.389-4.558).Significant interaction indicated that,in infection-or hemorrhage-related hydrocephalus,ETV carried ~2.5-fold higher early failure risk than VPS,whereas no difference existed for congenital/malformative,cystic,traumatic or tumor-related etiologies.The nomogram achieved an AUC of 0.831 (95%CI:0.744-0.919) with good calibration (Hosmer-Lemeshow χ2=6.328,P=0.610).DCA indicated net clinical benefit across threshold probabilities of ~8%-45%.Conclusions Etiology,surgical choice and preoperative ventricular size are key determinants of early postoperative failure after operation for pediatric hydrocephalus.FOHR-,etiology- and procedure-based nomogram has demonstrated solid discrimination and calibration.
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备注/Memo
收稿日期:2025-10-28。
基金项目:湖南省自然科学基金(2025JJ50682);湖南省卫生健康科研课题(20255490)
通讯作者:吴水华,Email:292454021@qq.com