Analysis of influencing factors of perioperative complications of laparoscopic right hemicolectomy and constructing a risk model based upon nomogram

Wu Guocong; Meng Cong; Wei Pengyu; Gao Jiale

doi:10.3969/j.issn.1003-5591.2024.04.005

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Analysis of influencing factors of perioperative complications of laparoscopic right hemicolectomy and constructing a risk model based upon nomogram

更新时间：2026-11-05

- Analysis of influencing factors of perioperative complications of laparoscopic right hemicolectomy and constructing a risk model based upon nomogram
- J Abdominal Surg Vol. 37, Issue 4, Pages: 255-260(2024)
- 作者机构：
  
  首都医科大学附属北京友谊医院普通外科，北京 100050
- 作者简介：
  
  Wu Guocong，Email：bjwugc1978@163.com
- 基金信息：
- DOI：10.3969/j.issn.1003-5591.2024.04.005
  CLC： R619
- Received：20 February 2024，
  
  Published：22 August 2024
- 稿件说明：
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吴国聪,孟聪,魏鹏宇等.腹腔镜右半结肠切除术围手术期并发症影响因素分析及列线图风险模型的构建[J].腹部外科,2024,37(04):255-260.

Wu Guocong,Meng Cong,Wei Pengyu,et al.Analysis of influencing factors of perioperative complications of laparoscopic right hemicolectomy and constructing a risk model based upon nomogram[J].J Abdominal Surg,2024,37(04):255-260.
吴国聪,孟聪,魏鹏宇等.腹腔镜右半结肠切除术围手术期并发症影响因素分析及列线图风险模型的构建[J].腹部外科,2024,37(04):255-260. DOI： 10.3969/j.issn.1003-5591.2024.04.005.

Wu Guocong,Meng Cong,Wei Pengyu,et al.Analysis of influencing factors of perioperative complications of laparoscopic right hemicolectomy and constructing a risk model based upon nomogram[J].J Abdominal Surg,2024,37(04):255-260. DOI： 10.3969/j.issn.1003-5591.2024.04.005.

摘要

目的

分析腹腔镜右半结肠切除术围手术期并发症影响因素，并构建预测腹腔镜右半结肠切除术围手术期并发症的列线图模型。

方法

回顾性选取2019年10月至2023年6月首都医科大学附属北京友谊医院普通外科胃肠病房收治的行腹腔镜右半结肠切除术病人223例，根据病人围手术期是否有并发症的发生，将其分为并发症组（

=42）和非并发症组（

=181）。多因素logistic回归分析腹腔镜右半结肠切除术围手术期并发症发生的影响因素，采用R4.3.2软件构建围手术期并发症发生的预测模型，受试者操作特征曲线分析列线图的预测价值，Hosmer-Lemeshow拟合优度检校准曲线评价列线图的拟合程度，决策曲线分析（DCA）评估预测模型的临床实用价值。

结果

223例行腹腔镜右半结肠切除术的病人中，围手术期内有42例发生并发症；多因素logistic 回归分析结果发现，合并糖尿病、手术时间＞3 h、肿瘤低分化、腹腔外吻合术和急性生理与慢性健康评分Ⅱ（APACHE-Ⅱ）≥14分是影响腹腔镜右半结肠切除术围手术期发生并发症的独立危险因素（

＜0.05）。将危险因素进行可视化风险预测列线图构建，可计算出腹腔镜右半结肠切除术围手术期并发症发生的预测概率；绘制列线图预测模型的DCA曲线，当预测概率阈值为0～0.6之间时，表明腹腔镜右半结肠切除术围手术期并发症的列线图模型的净收益率较高；受试者操作特征曲线下面积为0.941（95%

：0.893～0.988），灵敏度为87.46%，特异度为81.48%，提示列线图预测模型具有较好的判别能力。Hosmer-Lemeshow拟合优度检验（χ

=5.236，

=0.732），校准曲线的实际曲线位于理想曲线附近，提示的预测概率与实际概率具有较好的一致性。

结论

合并糖尿病、手术时间＞3 h、肿瘤低分化、腹腔外吻合术和APACHE-Ⅱ≥14分是影响腹腔镜右半结肠切除术围手术期发生并发症的独立危险因素，基于上述构建的列线图预测模型，准确度和区分度较好，具有较好的临床实用性。

Abstract

Objective

To explore the influencing factors for perioperative complications of right laparoscopic hemicolectomy and construct a risk model of column graph.

Methods

From October 2019 to June 2023， the relevant clinical data were retrospectively reviewed for 223 patients undergoing right laparoscopic hemicolectomy. They were divided into two groups of complication （

=42） and non-complication （

=181） according to whether or not complications occurred in perioperative period. Multivariate Logistic regression was utilized for examining the influencing factors for perioperative complications. R4.3.2 software was utilized for constructing a prediction model of perioperative complications. Receiver operating characteristic （ROC） curve was employed for measuring the predictive value of nomogram and Hosmer-Lemeshow goodness of fit calibration curve for evaluating the fitting degree of nomogram. Decision curve analysis （DCA） was employed for examining the clinical utility of predictive model.

Results

Among them， 42 patients had complications during perioperative period. Multivariate Logistic regression analysis indicated that diabetes mellitus （DM）， operative duration ＞3 h， low tumor differentiation， external abdominal anastomosis and APACHE-Ⅱ score ≥14 were independent risk factors for perioperative complications （

0.05）. The prediction probability of perioperative complications could be calculated by constructing the visualization risk prediction diagram of risk factors. DCA curve of nomogram prediction model was plotted. When prediction probability threshold was between 0 and 0.6， net return rate of nomogram model for perioperative complications was higher. The area under ROC curve was 0.941（95%

： 0.893-0.988） with a sensitivity of 87.46% and a specificity of 81.48%. It suggested that the nomogram prediction model had a decent discriminant capability. Hosmer-Lemeshow goodness of fit test

=5.236，

=0.732， actual curve of calibration curve approximated an ideal curve. Predicted probability accorded well with actual probability.

Conclusion

Concurrent DM， operative duration >3 h， low tumor differentiation， external abdominal anastomosis and APACHE-Ⅱ score ≥14 are independent risk factors for perioperative complications of laparoscopic right hemicolectomy. The prediction model based upon the above nomogram is both accurate and well-differentiated. Clinical practicability is excellent.

关键词

Keywords

references

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