结直肠息肉内镜黏膜下剥离术后早期康复的影响因素分析及列线图预测模型构建OA
Analysis of influencing factors of early rehabilitation after endoscopic submucosal dissection for colorectal polyps and construction of nomogram prediction model
目的:探讨结直肠息肉内镜黏膜下剥离术后患者早期康复的影响因素,并构建列线图预测模型.方法:本研究为回顾性研究,收集 2023 年 1 月至 2026 年 1 月接受内镜黏膜下剥离术的 400 例结直肠息肉患者的临床资料.患者 48～68 岁,平均(57.24±6.13)岁;男 240 例,女 160 例.术后第 3 天记录患者 15 项恢复质量评分量表(QoR-15)评分,根据标准将其分为评分＜118 分组(n=85)与评分≥118 分组(n=315).采用多因素 Logistic 回归模型分析患者 QoR-15 评分＜118 的影响因素.基于影响因素构建列线图预测模型,并评价其效能.结果:单因素分析结果显示,两组年龄、BMI、息肉最大直径、麻醉方式、加速康复外科措施执行情况差异有统计学意义(P＜0.05).多因素 Logistic 回归分析结果显示,高龄(OR=2.823)、高 BMI(OR=4.056)、息肉最大直径较大(OR=5.500)、全身麻醉(OR=4.162)、加速康复外科措施未全面执行(OR=6.025)是导致患者 QoR-15 评分＜118 分的影响因素(P＜0.05).基于影响因素构建列线图预测模型,受试者操作特征曲线下面积为 0.875,校准曲线显示拟合优度良好(χ2=3.522,P=0.773),决策曲线分析表明模型具有较好的临床净收益,内、外部验证结果均较理想.结论:结直肠息肉内镜黏膜下剥离术后患者早期康复影响因素的明确及列线图预测模型的构建有助于医疗卫生机构快速、精准地甄别高危群体,以便及时采取针对性措施,促进患者早期康复.
Objective:To explore the influencing factors of early rehabilitation in patients after endoscopic submucosal dissec-tion(ESD)for colorectal polyps,and to construct a nomogram prediction model.Methods:A retrospective analysis was performed on clinical data of 400 patients with colorectal polyps treated with ESD from Jan.2023 to Jan.2026.The patients'age ranged from 48 to 68 years,with an average of(57.24±6.13)years.There were 240 males and 160 females.On the 3rd day after operation,the 15-item quality of recovery-15(QoR-15)scores of patients were recorded.According to the standard,patients were divided into the score＜118 group(n=85)and score≥118 group(n=315).Multivariate logistic regression model was used to analyze the influencing factors of pa-tients with QoR-15 score＜118.A nomogram prediction model was constructed based on the influencing factors,and the efficacy of the model was evaluated.Results:Univariate analysis results indicated that there were statistically significant differences in age,body mass index,maximum polyp diameter,anesthesia method,and implementation of enhanced recovery after surgery(ERAS)measures be-tween the two groups(P＜0.05).Multivariate logistic regression analysis results indicated that advanced age(OR=2.823),high body mass index(OR=4.056),large maximum polyp diameter(OR=5.500),general anesthesia(OR=4.162),and incomplete implementa-tion of enhanced recovery after surgery measures(OR=6.025)were influencing factors for the patients with QoR-15 score＜118(P＜0.05).Based on the influencing factors,a nomogram prediction model was constructed.The area under the receiver operating charac-teristic curve of the model was 0.875,and the calibration curve indicated good goodness of fit(χ2=3.522,P=0.773).Decision curve analysis indicated that the model had good clinical net benefit.Both internal and external validation results were ideal.Conclusions:The clarification of influencing factors for early rehabilitation and the construction of nomogram prediction model for patients after ESD can help medical and health institutions rapidly and accurately identify high-risk groups,so as to take targeted measures in a timely manner and promote early rehabilitation of patients.
吴莉;陈丽娟;吕桂芬;江丹帝;文丹;田龙
上海市东方医院肛肠外科,上海,200120上海市东方医院肛肠外科,上海,200120上海市东方医院肛肠外科,上海,200120上海市东方医院肛肠外科,上海,200120上海市东方医院肛肠外科,上海,200120上海交通大学医学院附属新华医院普外科
医药卫生
结直肠息肉内镜黏膜下剥离术康复影响因素分析列线图
Colorectal polypEndoscopic submucosal dissectionRehabilitationRoot cause analysisNomograms
《腹腔镜外科杂志》 2026 (7)
508-514,7
上海市科学技术重点研发计划项目(2400140)
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