■研究的目的是根据临床因素开发预测列线图,以评估先天性胆总管囊肿患儿术后并发症的风险。
■回顾性分析2016年1月至2022年12月在我院行胆总管囊肿切除和肝空肠Roux-en-Y吻合术的131例患儿的临床资料。一般资料,临床症状,procedure,生化指标,并记录影像学数据。由术后并发症引起的住院时间延长或随访超过6个月被评估为事件结果。进行物流回归分析,以筛选在诱发术后并发症中具有统计学意义的危险因素。然后,将数据集拆分为训练组和内部验证组,预测术后并发症的列线图是基于计算机算法制定的.此外,受试者工作特征(ROC)曲线和校准曲线用于列线图验证.
■131个孩子,多元物流回归分析表明,年龄≤2岁[比值比(OR)0.93;95%置信区间(CI)0.15-5.65;p=0.938],Todani分类类型1(OR36.58;95%CI4.14-871.74;p=0.005),囊壁厚度>0.4cm(OR10.82;95%CI2.88-49.13;p<0.001),慢性胆囊炎(OR7.01;95%CI1.62-38.52;p=0.014),和胆总管囊肿直径(OR1.01;95%CI0.99-1.03;p=0.370)是与胆总管囊肿术后并发症相关的预测因子。将数据随机分为训练组(n=92)和内部验证组(n=39),以构建包括上诉因子的预测列线图。使用ROC曲线和校准曲线评估模型的准确性和区分度。结果显示,ROC曲线下的列线图面积[曲线下面积(AUC)=0.894;95%CI0.822-0.966;p<0.001],验证(AUC=0.844;95%CI0.804-0.952;p<0.001),Brier=0.120(95%CI0.077-0.163p;p<0.001)表明预测列线图具有良好的稳定性和校准性。
■先天性胆总管囊肿的预后与多种临床因素有关。结合内部验证,新的预测列线图适用于评估胆总管囊肿术后并发症的个体化风险.预测列线图可以为胆总管囊肿患儿提供更准确的手术和术后随访策略。
UNASSIGNED: The aim of the study was to develop a prediction nomogram based on clinical factors to assess the risk of postoperative complications in children with congenital choledochal cyst.
UNASSIGNED: The clinical data from 131 children who underwent choledochal cyst resection and Roux-en-Y hepaticojejunostomy in our hospital between January 2016 and December 2022 were retrospectively analyzed. The general information, clinical symptoms, procedure, biochemical indicators, and imaging data were recorded. A prolonged hospital stay induced by postoperative complications or a follow-up over 6 months was assessed as the event outcome. A logistics regression analysis was performed to screen for risk factors with statistical significance in inducing postoperative complications. Then, with the dataset split into the training group and internal validation group, the nomogram for the prediction of postoperative complications was developed based on a computer algorithm. In addition, the receiver operating characteristic (ROC) curve and calibration curve were performed for nomogram verification.
UNASSIGNED: Of 131 children, the multivariate logistics regression analysis suggested that age ≤2 years [odds ratio (OR) 0.93; 95% confidence interval (CI) 0.15-5.65; p = 0.938], Todani classification type 1 (OR 36.58; 95% CI 4.14-871.74; p = 0.005), cyst wall thickness >0.4 cm (OR 10.82; 95% CI 2.88-49.13; p < 0.001), with chronic cholecystitis (OR 7.01; 95% CI 1.62-38.52; p = 0.014), and choledochal cyst diameter (OR 1.01; 95% CI 0.99-1.03; p = 0.370) were predictors associated with the postoperative complications of choledochal cysts. The data were randomly divided into the training group (n = 92) and internal validation group (n = 39) to build the prediction nomogram including the appeal factors. The accuracy and discrimination of the model were evaluated using a ROC curve and calibration curve. The results showed that the nomogram area under the ROC curve [area under the curve (AUC) = 0.894; 95% CI 0.822-0.966; p < 0.001], validation (AUC = 0.844; 95% CI 0.804-0.952; p < 0.001), and Brier = 0.120 (95% CI 0.077-0.163p; p < 0.001) were indicative of the good stability and calibration of the predictive nomogram.
UNASSIGNED: The prognosis of congenital choledochal cysts was associated with multiple aspects of clinical factors. Combined with the internal validation, the novel prediction nomogram was suitable for evaluating the individualized risk of postoperative complications of choledochal cysts. The prediction nomogram could provide a more accurate strategy of procedure and postoperative follow-up for children with choledochal cysts.