摘要
目的探讨前列腺增生患者经尿道前列腺电切术后并发下肢静脉血栓栓塞(VTE)的相关危险因素。方法回顾性收集2018年7月—2022年8月于首都医科大学附属北京友谊医院接受经尿道前列腺电切术治疗的464例前列腺增生患者的临床资料,包括基本信息、前列腺体积、手术时间、Caprini评分、血浆D-二聚体水平、术后并发症等。按是否发生下肢VTE分为两组:VTE组(n=25)与非VTE组(n=439)。采用单因素和多因素Logistic回归分析确定下肢VTE的潜在危险因素,建立风险预测模型并绘制列线图,并采用Bootstrap法进行内部验证,制作校正曲线,以一致性指数(C-index)和R^(2)对模型的预测能力进行验证。结果464例患者中,下肢VTE发生率为5.4%(25/464),共有1.9%(9/464)的患者被诊断为深静脉血栓栓塞,无肺栓塞发生。VTE组与非VTE组在Caprini评分、手术时间、年龄、糖尿病、吸烟史、既往血栓史方面差异具有统计学意义(P<0.05)。单因素分析结果显示,年龄、手术时间、Caprini评分、糖尿病史、吸烟史和既往血栓史可能是经尿道前列腺电切术后发生下肢VTE的危险因素。多因素Logistic回归分析结果显示,手术时间(OR=37.429,P=0.001)、Caprini评分(OR=3.306,P<0.001)是经尿道前列腺电切术后发生下肢VTE的独立危险因素。其中手术时间<60 min相对于>90 min患者,经尿道前列腺电切术后发生下肢VTE风险明显降低(OR=0.024,P<0.001)、Caprini评分4、5分相对于7分患者经尿道前列腺电切术后发生下肢VTE风险明显降低(OR=0.041、0.082,P=0.004、0.003)。根据多因素Logistic回归分析结果绘制列线图,Bootstrap法内部验证后提示列线图具有较好的预测能力,C-index为0.935,95%CI:0.906~0.965,R^(2)为0.451。结论Caprini评分和手术时间是影响前列腺增生患者经尿道前列腺电切术后发生下肢VTE的独立危险因素。包含手术时间、Caprini评分在内的列线图模型具有较好的预测效能,可帮助医务人员早期预测经尿道前列腺电切术后并发下肢VTE的风险。
Objective To investigate the risk factors of lower extremity venous thromboembolism(VTE)after transurethral resection of prostate(TURP)in patients with prostatic hyperplasia.Methods The clinical data of 464 patients with prostatic hyperplasia who underwent TURP in Beijing Friendship Hospital,Capital Medical University from July 2018 to August 2022 were collected retrospectively.Including basic information,prostate volume,operation time,Caprini score,plasma D-dimer level,postoperative complications and so on.They were divided into two groups according to whether lower extremity VTE occurs:VTE group(n=25)and non-VTE group(n=439).The potential risk factors of lower extremity VTE were determined by univariate analysis and multivariate Logistic regression analysis,the risk prediction model was established,and the nomogram was drawn,the internal verification of Bootstrap was carried out,the correction curve was made,and the prediction ability of the model was verified by consistency index(C-index)and R^(2).Results Among 464 patients,the incidence of lower extremity VTE was 5.4%(25/464).A total of 1.9%of the patients were diagnosed with deep venous thromboembolism and no pulmonary thromboembolism occurred.There were significant differences in Caprini score,operation time,age,diabetes,smoking history and previous thrombus history between VTE group and non-VTE group.Univariate analysis showed that age,operation time,Caprini score,history of diabetes,smoking and previous history of thrombosis may be the risk factors of postoperative lower extremity VTE.Multivariate Logistic regression analysis showed that operation time(OR=37.429,P=0.001)and Caprini score(OR=3.306,P<0.001)were independent risk factors for postoperative lower extremity VTE.The risk of postoperative lower extremity VTE in patients with less than 60 minutes of operation was significantly lower than that in patients with more than 90 minutes(OR=0.024,P<0.001),and the risk of postoperative lower extremity VTE in patients with Caprini scores of 4 and 5 was significantly lower than that of patients with 7 points(OR=0.041 and 0.082,P=0.004 and 0.003).The nomogram was drawn according to the results of multivariate Logstic regression analysis.After internal verification,it was suggested that the nomogram has better prediction ability,C-index was 0.935,95%CI:0.906-0.965,R^(2)was 0.451.Conclusions Caprini score and operation time are independent risk factors for lower extremity VTE after TURP of patients with prostatic hyperplasia.The nomogram model including operation time and Caprini score has good predictive efficiency and can help medical staff to predict the risk of lower extremity VTE after TURP.
作者
宋菲菲
张娣
石蕊
Song Feifei;Zhang Di;Shi Rui(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《国际外科学杂志》
2023年第10期658-664,I0004,共8页
International Journal of Surgery
基金
北京市医院管理中心"青苗"计划专项经费资助(QML20190106)。
关键词
前列腺增生
静脉血栓栓塞
列线图
经尿道前列腺电切术
Prostatic hyperplasia
Venous thromboembolism
Nomograms
Transurethral resection of prostate
作者简介
通信作者:宋菲菲,Email:869162375@qq.com。
