胰体尾切除术后胰漏风险预测模型的构建及验证

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Construction and validation of a risk prediction model for postoperative pancreatic fistula after distal pancreatectomy

Abstract  Objective：To explore the risk factors of postoperative pancreatic fistula（POPF） after distal pancreatectomy（DP）， and to establish a risk prediction model.Methods：Clinical data of 366 patients who underwent DP in the pancreatic cancer department， Tianjin Medical University Cancer Institute and Hospital from March 2020 to September 2022 were collected retrospectively， and were randomly assigned to a training group （n=276） and a verification group （n=90） according to the ratio of 3∶1.Firstly， based on the training group， the risk factors of POPF were screened through multivariate Logistic regression， and Nomogram was constructed.Then， the discrimination， calibration and clinical applicability of the model were tested by the training group and the verification group.Results：Among the 276 cases in the training group， 61 had POPF， the incidence rate was 22.1%. The results of multivariate Logistic regression showed that male，preoperative haemoglobin≥133.5 g/L， open surgery， intraoperative radiotherapy， operation time≥237.5 min， drain fluid amylase on postoperative day 1 （DFA1）≥2 424.0 U/L were influencing factors for POPF after DP. According to the multivariate Logistic regression， the Nomogram prediction model was constructed. The AUC of ROC in the training group and the verification group were 0.791（95%CI 0.725⁃0.858） and 0.755（95%CI 0.637⁃0.872）， respectively. The clinical decision curve showed that the threshold probability interval of the maximum net benefit value of the POPF predicted by the model in the training group and the verification group were 7%⁃70% and 6%⁃61%，respectively.Conclusions：Male， preoperative haemoglobin≥133.5 g/L， open surgery， intraoperative radiotherapy，operation time≥237.5 min， DFA1≥2 424 U/L were risk factors for POPF after DP. The Nomogram constructed based on the above variables can provide reference for clinical prevention of POPF.

Keywords    distal pancreatectomy， DP； postoperative pancreatic fistula， POPF； risk factors； prediction model； Nomogram

摘要  目的：探讨胰体尾切除术后病人发生术后胰漏的风险因素，并构建风险预测模型。（剩余11054字）