混合痔患者术后尿潴留发生的影响因素及其列线图预测模型构建OA
Influencing Factors of Postoperative Urinary Retention in Patients with Mixed Hemorrhoids and Construction of a Nomogram Prediction model
目的:探讨混合痔患者术后尿潴留发生的影响因素并构建列线图预测模型.方法:纳入 2021 年 6 月—2025 年 6 月期间在中国人民解放军联勤保障部队第九〇七医院行手术治疗的 449 例混合痔患者,依据 7∶3 的比例随机分为训练集(n=314)和验证集(n=135),根据术后尿潴留发生情况将训练集患者分为未发生组(n=258)和发生组(n=56),收集麻醉方式、外痔切除数、术后 3 h 视觉模拟量表(VAS)评分等资料.采用多因素 logistic 回归分析筛选训练集混合痔患者发生术后尿潴留的独立影响因素,构建列线图预测模型;采用Bootstrap 法对列线图预测模型进行验证,校准曲线、受试者工作特征(ROC)曲线、决策曲线分析(DCA)曲线分别用于评估模型的校准度、区分度和临床适用性.结果:训练集和验证集性别、年龄、病程等资料比较,差异均无统计学意义(P>0.05).发生组便秘、硬膜外麻醉、外痔切除数≥3 个、压力敷料比例及术后 3 h VAS 评分高于未发生组,差异有统计学意义(P<0.05).有便秘、硬膜外麻醉、外痔切除数≥3 个、压力敷料、术后 3 h VAS 评分较高为混合痔患者发生术后尿潴留的独立影响因素(P<0.05).训练集和验证集校准曲线结果显示,实际观测值与预测概率基本一致,Hosmer-Lemeshow 拟合优度检验 χ2=7.178、0.645,P=0.518、0.813;ROC 曲线结果显示,AUC 分别为 0.843(95%CI:0.784～0.903)、0.823(95%CI:0.755～0.891);DCA 曲线结果显示,风险阈值概率在 0.08～0.89、0.09～0.90 范围内,列线图预测模型的临床净收益均较高.结论:本研究开发的列线图可有效预测混合痔患者发生术后尿潴留的风险.
Objective:To explore the influencing factors of postoperative urinary retention in patients with mixed hemorrhoids and construct a nomogram prediction model.Method:449 patients with mixed hemorrhoids who underwent surgical treatment from June 2021 to June 2025 in the 907th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army were included and randomly assigned into the training set(n=314)and the validation set(n=135)at a ratio of 7:3.According to the occurrence of postoperative urinary retention,the patients in the training set were further assigned into the non-occurrence group(n=258)and the occurrence group(n=56).Data such as anesthesia methods,the number of resected external hemorrhoids,and the postoperative 3 h Visual Analogue Scale(VAS)score were collected.Multivariate logistic regression analysis was used to screen for independent influencing factors of postoperative urinary retention in patients with mixed hemorrhoids in the training set,and a nomogram prediction model was constructed.The Bootstrap method was used to validate the nomogram prediction model,and the calibration curve,receiver operating characteristic(ROC)curve,and decision curve analysis(DCA)curve were respectively employed to evaluate the calibration,discrimination,and clinical applicability of the model.Result:There were no statistical differences in gender,age,disease duration and other data between the training set and the validation set(P>0.05).The occurrence group had higher proportions of constipation,epidural anesthesia,the number of resected external hemorrhoids≥3,pressure dressings,and the postoperative 3 h VAS score than the non-occurrence group,with statistically significant differences(P<0.05).Constipation,epidural anesthesia,the number of resected external hemorrhoids≥3,pressure dressings,and a higher postoperative 3 h VAS score were independent influencing factors for postoperative urinary retention in patients with mixed hemorrhoids(P<0.05).The calibration curve results of the training set and the validation set showed that the actual observed values were basically consistent with the predicted probabilities,and the Hosmer-Lemeshow goodness-of-fit test had χ2=7.178,0.645,P=0.518,0.813.The ROC curve results showed that the AUC values were 0.843(95%CI:0.784～0.903)and 0.823(95%CI:0.755～.891),respectively.The DCA curve results showed that when the risk threshold probability was within the range of 0.08～0.89 and 0.09～0.90,the clinical net benefit of the nomogram prediction model was relatively high.Conclusion:The nomogram developed in this study can effectively predict the risk of postoperative urinary retention in patients with mixed hemorrhoids.
肖凡;董骏
中国人民解放军联勤保障部队第九〇七医院 福建 南平 353099中国人民解放军联勤保障部队第九〇七医院 福建 南平 353099
混合痔术后尿潴留影响因素列线图预测
Mixed hemorrhoidsPostoperative urinary retentionInfluencing factorsNomogramPrediction
《中外医学研究》 2026 (21)
1-6,6
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