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2025, 05, v.28 337-342
胸乳入路腔镜甲状腺手术后血清肿的预测模型构建
基金项目(Foundation): 广东省医学科学技术研究基金项目(B2023334); 广东省东莞市社会科技发展(重点)项目(202050715046226)
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DOI:
摘要:

目的:探索胸乳入路腔镜甲状腺手术(ETBA)后血清肿的相关预后因素,并构建列线图预测发生血清肿的可能性。方法:回顾性分析东莞东华医院2022年1月—2024年5月及东莞松山湖东华医院2023年1月—2024年8月行腔镜甲状腺手术的患者资料,筛选出1493例符合纳入标准的患者。其中东莞东华医院有1048例,作为训练集,无血清肿组1015例,有血清肿组33例;东莞松山湖东华医院有445例,作为验证集,无血清肿组424例,有血清肿组21例。多因素Logistic回归分析相关独立预后因素,R软件建立列线图预测模型。通过校准曲线、Hosmer-Lemeshow拟合优度、ROC曲线对列线图预测模型的效能进行评估,并通过临床决策曲线评估临床实用性。结果:多因素Logistic回归分析得出行中央区淋巴结清扫、患有糖尿病、甲状腺功能亢进症、结节大小是ETBA术后发生血清肿的相关独立预后因素(P<0.05)。基于预后因素构建ETBA术后血清肿的列线图。训练组与验证组的校准曲线与观测结果吻合较好,Hosmer-Lemeshow拟合优度检验良好(训练集P=0.244,验证集P=0.803)。训练集ROC曲线显示AUC为0.810(95%CI:0.740~0.879),验证集ROC曲线显示AUC为0.815(95%CI:0.722~0.909)。结论:基于多因素Logistic回归分析得出的相关预后因素所构建的列线图模型,对ETBA术后血清肿具有良好的预测作用,可以为患者提供合理及个体化的治疗方案。

Abstract:

Objective: To explore the prognostic factors of seroma after endoscopic thyroidectomy by breast approach, and construct a nomogram to predict the possibility of cervical seroma. Methods: Data of patients undergoing endoscopic thyroid surgery in Dongguan Tungwah Hospital from January 2022 to May 2024 and Dongguan Songshan Lake Tungwah Hospital from May 2023 to August 2024 were retrospectively analyzed, and 1493 patients meeting the inclusion criteria were selected. Among them, there were 1048 patients in Dongguan Tungwah Hospital as the training cohort, 1015 patients without seroma group and 33 patients with seroma group. There were 445 patients in Dongguan Songshan Lake Tungwah Hospital as the verification cohort, including 424 patients without seroma and 21 patients with seroma. Multivariate logistic regression analysis was used to obtain relevant independent prognostic factors, and R software established a nomogram model. Calibration curves, Hosmer-Lemeshow goodness of fit, ROC curves were used to evaluate the calibrability of the nomogram model, and clinical utility was assessed by clinical decision curves. Results:Multivariate logistic regression analysis showed that central lymph node dissection, diabetes, hyperthyroidism, and nodule size were independent prognostic factors related to seroma. Based on the prognostic factors, the nomogram of seroma after ETBA was constructed. The calibration curves of the training and the verification group were in good agreement with the observed results, and the Hosmer-Lemeshow goodness of fit test was good, with the training cohort P=0.244 and the verification cohort P=0.803. The ROC curve of the training cohort showed that the area under the curve was 0.810(95% CI: 0.740~0.879), and the ROC curve of the verification cohort showed that the area under the curve was 0.815(95% CI: 0.722~0.909). Conclusion: The nomogram model based on the relevant prognostic factors obtained by multivariate logistic regression analysis has a good prediction effect on the seroma after ETBA, and can provide reasonable and individualized treatment plan for patients.

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基本信息:

DOI:

中图分类号:R653

引用信息:

[1]杨声飞,张运达,刘铭等.胸乳入路腔镜甲状腺手术后血清肿的预测模型构建[J].中国现代普通外科进展,2025,28(05):337-342.

基金信息:

广东省医学科学技术研究基金项目(B2023334); 广东省东莞市社会科技发展(重点)项目(202050715046226)

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