Construction and Validation of Nomogram Model to Predict the Risk of Intestinal Adhesion After Laparoscopic Cholecystectomy in Patients with Gallstones
Objective To analyze the risk factors of intestinal adhesion after laparoscopic cholecystectomy for cholecystolithiasis,construct the risk prediction Nomogram model and verify it.Methods A retrospective analysis was made on the clinical data of 429 cases of cholecystolithiasis treated by laparoscopic cholecystectomy from January 2017 to February 23 in the Second People's Hospital of Henan Province,which were divided into training set(286 cases)and validation set(143 cases).The training set was divided into an occurrence group(41 cases)and a non-occurrence group(245 cases)based on whether postoperative intestinal adhesions occur.Logistic regression analysis was performed on the risk factors of postoperative intestinal adhesions,and R software was used to construct a risk prediction Nomogarm model.Based on this model,internal validation,receiver operating characteristic(ROC)curve analysis,and decision curve analysis(DCA)were performed on the training set and validation set data to verify their effectiveness.Results There were no differences in general data between the training set and the validation set(P＞0.05).Bile extraction through umbilical hole incision(OR=5.546,95％CI:1.468-20.945),length of service of the performer(OR=0.590,95％CI:0.364-0.955),using medication to prevent intestinal adhesions(OR=0.557,95％CI:0.332-0.932)and C-reaction protein(CRP)(OR=5.960,95％CI:1.693-20.975)were all influencing factors for postoperative intestinal adhesion(P＜0.05).Based on the above risk factor analysis results,a Nomogram model for predicting the risk of postoperative intestinal adhesions was constructed.The Bootstrap method validation found that the C-index values were 0.889 and 0.830,respectively.And the calibration curve and standard curve had good fit.The ROC curve showed that the model had good predictive performance for postoperative intestinal adhesions.DCA showed ideal clinical net incomes.Conclusion Bile extraction through umbilical hole incision,the length of service of the operator,using medication to prevent intestinal adhesions and CRP are all the influencing factors of intestinal adhesion after laparoscopic cholecystectomy,and the Nomogram model constructed based on this is worth promoting and applying.
万方数据
维普
