无充气腋窝入路腔镜甲状腺手术后并发症风险模型的构建OA

Objective To investigate the influencing factors for postoperative complications following endoscopic thyroidectomy through gasless unilateral axillary approach(ETGUA)and construct a corresponding risk prediction model.Methods A retrospective analysis was conducted on the clinical data of 220 patients with thyroid tumors who underwent ETGUA in our hospital from January 2023 to March 2025.The patients were divided into the non-complication group(n=189)and the complication group(n=31)based on whether postoperative complications occurred.The univariate analysis and multivariate Logistic regression analysis were conducted to identify the influencing factors for complications after ETGUA treatment in patients with thyroid tumors,and then a Logistic regression prediction model was constructed and visualized with a nomogram.The predictive efficacy,calibration degree and clinical practicability of the model were evaluated using the receiver operating characteristic(ROC)curve,Hosmer-Lemeshow goodness-of-fit test,and decision curve analysis(DCA).Results The results of multivariate Logistic regression analysis showed that low levels of preoperative parathyroid hormone(PTH)and PTH on the first day after surgery were both independent risk factors for complications after ETGUA in patients with thyroid tumors(P<0.05).Based on these factors,a Logistic regression risk prediction model was constructed[Logit(P)=3.835-0.044×preoperative PTH-0.055×PTH on the first day after surgery],and a nomogram was drawn.The ROC curve analysis showed that the area under the curve(AUC)of this model for predicting complications was 0.779(95%CI:0.687 to 0.870),with a sensitivity of 71.00%,a specificity of 81.00%,and a Youden index of 0.520.The Hosmer-Lemeshow goodness-of-fit test showed that the predicted probability of the model was in good agreement with the actual probability(χ2=4.347,degrees of freedom=8,P=0.825).DCA showed that the net benefit of the model was significantly higher within the threshold probability range of 0.05 to 0.40.Conclusion Lower preoperative PTH and PTH on the first day after surgery are influencing factors for postoperative complications in thyroid tumors patients treated with ETGUA.The risk prediction model constructed based on the two factors has a relatively high predictive value,which can provide certain references for clinical prevention and treatment.