口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (8): 564-570.DOI: 10.12016/j.issn.2096-1456.2022.08.005

• 临床研究 • 上一篇    下一篇

口腔颌面恶性肿瘤患者术后发生便秘风险预测模型构建

朱惠璇(), 何杏芳(), 黄秋雨, 刘满凤, 林艳彤   

  1. 中山大学光华口腔医学院·附属口腔医院,广东省口腔医学重点实验室, 广东 广州(510055)
  • 收稿日期:2021-09-10 修回日期:2021-11-29 出版日期:2022-08-20 发布日期:2022-05-09
  • 通讯作者: 何杏芳
  • 作者简介:朱惠璇,护师,学士,Email: 548897851@qq.com
  • 基金资助:
    广东省医学科研基金项目(B2021231)

Establishment of a risk prediction model for postoperative constipation in patients with oral and maxillofacial malignant tumors

ZHU Huixuan(), HE Xingfang(), HUANG Qiuyu, LIU Manfeng, LIN Yantong   

  1. Stomatological Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2021-09-10 Revised:2021-11-29 Online:2022-08-20 Published:2022-05-09
  • Contact: HE Xingfang
  • Supported by:
    Medical Research Fund project of Guangdong Province(B2021231)

摘要:

目的 了解口腔颌面恶性肿瘤患者术后便秘发生情况与便秘影响因素,构建便秘风险预测模型,为防治术后便秘提供参考。方法 回顾性分析2019年6月至2020年6月在中山大学附属口腔医院行口腔颌面恶性肿瘤手术的191例患者资料,采用单因素分析和Logistic多因素回归分析筛选出独立影响因素,建立风险预测列线图,采用ROC曲线下面积对预测模型进行评价。内部和外部均采用C指数验证该模型的准确度。结果 191例患者中有52例(27.23%)术后出现便秘症状。单因素分析显示,术前便秘史、进食能全素、气管切开、吸烟、喝酒、手术时长、出血量、卧床时间、进食匀浆膳、性别、手术修补方式、使用益生菌、癌症T分期、进食量均可能是口腔颌面恶性肿瘤患者术后便秘的影响因素(P<0.05)。多因素分析结果显示,修补方式、卧床时间、性别是口腔颌面恶性肿瘤患者术后便秘的独立危险因素(P<0.05),修补方式为腓骨瓣、卧床时间长、男性患者术后易出现便秘。将修补方式、卧床时间、性别纳入预测模型中,训练组和验证组的C指数值分别为0.882和0.953;训练组的ROC曲线下面积为0.909(95%CI: 0.850 ~ 0.968),验证组的ROC曲线下面积为0.893(95%CI: 0.787 ~ 0.999),列线图显示出良好的鉴别能力。结论 修补方式、卧床时间、性别是口腔颌面恶性肿瘤患者术后便秘的独立危险因素,构建的风险预测模型有较好的判别能力。

关键词: 便秘, 术后, 口腔颌面部, 外科, 恶性肿瘤, 风险预测, 模型, 危险因素

Abstract:

Objective To understand the incidence and influencing factors of postoperative constipation in patients with malignant tumors who undergo oral and maxillofacial surgery and construct a constipation risk prediction model to provide a reference for the prevention and treatment of postoperative constipation. Methods The data of 191 patients who underwent oral and maxillofacial malignant tumor surgery at the Affiliated Stomatological Hospital of Sun Yat sen University from June 2019 to June 2020 were analyzed retrospectively. The independent influencing factors were selected via univariate analysis and logistic multivariate regression analysis, a risk prediction nomogram was established, and the prediction model was evaluated by the area under the ROC curve. Both internal and external use the C index to verify the accuracy of the model. Results Among 191 patients, 52 (27.23%) had postoperative constipation. Univariate analysis showed that a preoperative secret history of defecation, total energy intake, tracheotomy, smoking, drinking, operation duration, bleeding volume, bed time, eating homogenate diet, sex, surgical repair method, use of probiotics, T-stage of cancer and food intake may be the influencing factors of postoperative constipation in patients with oral and maxillofacial malignant tumors (P<0.05). Multivariate analysis showed that repair method, bed time and sex were independent risk factors for postoperative constipation in patients with oral and maxillofacial malignant tumors (P<0.05). The repair method was a fibular myocutaneous flap with a long bed time, and male patients were prone to constipation after surgery. The c-index values in the training group and the verification group were 0.882 and 0.953, respectively. The area under the ROC curve of the training group was 0.909 (95%CI: 0.850-0.968), and the area under the ROC curve of the verification group was 0.893 (95%CI: 0.787-0.999). The nomogram showed good discrimination ability. Conclusion The repair method, bed time and sex are independent risk factors for postoperative constipation in patients with oral and maxillofacial malignant tumors. The risk prediction model has good discrimination ability.

Key words: constipation, postoperative, oral and maxillofacial, surgical, malignant tumors, risk prediction, model, risk factor

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