摘要
目的 探讨混合痔外剥内扎切除术后发生尿潴留的危险因素,并构建其预测模型.方法 收集 2018-12 至2023-11 于联勤保障部队第 908 医院行外剥内扎切除术治疗的 532 例混合痔患者的临床资料.根据术后是否发生尿潴留分为尿潴留组(n=62)和非尿潴留组(n=470).通过受试者工作特征(ROC)曲线获取各因素的最佳截断值;logistic多元回归模型分析混合痔外剥内扎切除术后发生尿潴留的独立危险因素并构建预测模型,校正曲线对预测模型进行内部验证,决策曲线评估预测模型的预测效能.结果 两组患者在性别、BMI、婚姻状况、肛裂等方面无统计学差异;尿潴留组年龄、合并糖尿病比例、硬膜外麻醉比例、便秘比例、HAMA评分、VAS评分、套扎内痔点数、手术时间均高于或长于非尿潴留组,差异具有统计学意义(P<0.05).ROC曲线分析结果显示:年龄、HAMA评分、VAS评分、套扎内痔点数、手术时间的最佳截断值分别为 60 岁、13 分、6 分、3 个、40 min.logistic多元回归模型结果显示:年龄(>60 岁)、合并糖尿病、便秘、HAMA评分(>13 分)、VAS评分(>6 分)、手术时间(>40 min)是混合痔外剥内扎切除术后发生尿潴留的独立危险因素(P<0.05).内部验证结果显示,预测模型对混合痔外剥内扎切除术后发生尿潴留预测的C-index为 0.957(0.929～0.985).观测值与预测值间一致性较好.预测模型预测混合痔外剥内扎切除术后发生尿潴留的阈值>0.22,预测模型提供的临床净收益均高于年龄、合并糖尿病、便秘、HA-MA评分、VAS评分、手术时间.结论 本研究基于年龄、合并糖尿病、便秘、HAMA评分、VAS评分、手术时间构建了预测混合痔外剥内扎切除术后发生尿潴留的预测模型,该模型对于混合痔外剥内扎切除术后发生尿潴留的预测价值较好,可为临床改善患者预后提供依据.
Abstract
Objective To investigate the risk factors of urinary retention after external stripping and internal ligation of mixed hemorrhoids and to construct a prediction model.Methods Clinical data of 532 patients with mixed hemorrhoids who underwent exter-nal stripping and internal ligation treatment at the 908th Hospital of PLA Joint Logistics Support Force from December 2018 to Novem-ber 2023 in our hospital were collected,and the patients were categorized into urinary retention group(n=62)and non-urinary reten-tion group(n=470)according to whether urinary retention occurred after surgery.The optimal cut-off values of each factor were ana-lyzed by receiver operating characteristic(ROC)curve.logistic multiple regression model was used to analyze the independent risk factors for the occurrence of urinary retention after external stripping and internal ligation of mixed hemorrhoids and to construct a pre-diction model,the correction curve was used to internally validate the prediction model,and decision curve was used to assess the pre-dictive efficacy of the prediction model.Results There was no statistically significant difference between the two groups in terms of gender,BMI,marital status,and anal fissure(P>0.05);the age,proportion of comorbid diabetes mellitus,proportion of epidural an-esthesia,proportion of constipation,HAMA score,VAS score,number of points of ligated internal hemorrhoids,and operative time of the urinary retention group were higher than those of the non-urinary retention group,and the difference was statistically significant(P<0.05).ROC curve analysis showed that the optimal cut-off values for age,HAMA score,VAS score,number of points for lancing internal hemorrhoids,and operative time were 60 years,13 points,6 points,3,and 40 min,respectively.Logistic multiple regression model showed that age(>60 years),comorbid diabetes mellitus(yes),constipation(yes),HAMA score(>13),VAS score(>6),and operative time(>40 min)were the independent risk factors for the development of urinary retention after the excision of mixed hemorrhoids(P<0.05).Internal validation showed that the C-index of the prediction model for predicting the occurrence of urinary reten-tion after the excision of mixed hemorrhoids was 0.957(0.929-0.985).The agreement between observed and predicted values was good.The prediction model predicted a threshold of>0.22 for the occurrence of urinary retention after external and internal ligation ex-cision of mixed hemorrhoids,and the prediction model provided a net clinical benefit over age,comorbid diabetes,constipation,HA-MA score,VAS score,and operative time.Conclusions In this study,a prediction model is constructed to predict the occurrence of urinary retention after external stripping and internal ligation of mixed hemorrhoids based on age,comorbid diabetes mellitus,constipa-tion,HAMA score,VAS score,and operation time,which has a good predictive value for the occurrence of urinary retention after the resection,and can provide a basis for clinical improvement of patients'prognosis.
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