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| 基于NEU/ALB联合临床特征列线图模型预测TAPP患者并发血清肿的研究 |
| A preliminary study on a nomogram model combining NEU/ALB and clinical features for predicting seroma formation in patients undergoing TAPP |
| 投稿时间：2025-12-20 |
| DOI：10.3969/j.issn.1000-0399.2026.06.015 |
| 中文关键词: 腹腔镜经腹腹膜前疝修补术 血清肿 中性粒细胞/清蛋白比值 列线图 |
| 英文关键词: Laparoscopic transabdominal preperitoneal hernia repair Seroma Neutrophil-to-albumin ratio Nomogram |
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| 中文摘要: |
| 目的 探讨腹股沟疝腹腔镜经腹腹膜前疝修补术（TAPP）患者并发血清肿的独立危险因素并构建列线图预测模型。方法 回顾性分析2021年12月至2025年10月于安徽医科大学附属滁州医院行TAPP手术的400例患者的临床资料，根据术后是否发生血清肿分为发生组（n=52）与未发生组（n=348）。采用单因素及多因素logistic回归分析筛选TAPP术后患者并发血清肿的独立危险因素，并构建列线图预测模型。通过受试者工作特征（ROC）曲线、Bootstrap法内部验证、校准曲线及决策曲线评估模型的区分度、校准度与临床实用性。结果 TAPP术后患者血清肿发生率为13.00%。多因素logistic回归分析确定抗凝药物使用史（OR=2.353,95%CI:1.014～5.458,P=0.046）、疝分型（Ⅲ/Ⅳ型）(OR=2.371,95%CI:1.043～5.389,P=0.039)、疝囊直径≥5 cm（OR=2.815,95%CI:1.259～6.291,P=0.012）和中性粒细胞/清蛋白比值（NEU/ALB）升高（OR=3.821,95%CI:2.484～5.878,P<0.001）为TAPP患者血清肿发生的独立危险因素。基于危险因素构建风险预测模型：Logit（P）=-3.490+抗凝药物使用史×0.856+疝分型×0.863+疝囊直径×1.035+NEU/ALB×1.341,ROC曲线下面积（AUC）为0.867，灵敏度为80.80%，特异度为77.90%。经Bootstrap法内部验证和Hosmer-Lemeshow检验显示模型拟合良好（χ2=6.672,P=0.572），预测曲线与标准模型曲线拟合度较高。结论 本研究构建的基于NEU/ALB联合临床特征的列线图模型对TAPP患者并发血清肿具有良好的预测能力，有助于术前识别高危患者。 |
| 英文摘要: |
| Objective To investigate the independent risk factors for seroma formation in patients undergoing transabdominal preperitoneal（TAPP） laparoscopic inguinal hernia repair, and to construct a nomogram prediction model. Methods: A retrospective analysis was conducted on the clinical data of 400 patients who underwent TAPP surgery at the Affiliated Chuzhou Hospital of Anhui Medical University between December 2021 and October 2025. Patients were divided into a seroma group（n=52） and a nonseroma group（n=348） based on the occurrence of postoperative seroma. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for seroma following TAPP, and a nomogram prediction model was subsequently constructed. Model discrimination, calibration, and clinical utility were as assessed using the receiver operating characteristic（ROC） curve, Bootstrap internal validation, calibration curve, and decision curve analysis. Results The incidence of postoperative seroma after TAPP was 13.00%. Multivariate logistic regression analysis identified a history of anticoagulant use（OR=2.353, 95% CI: 1.014～5.458, P=0.046）, hernia type（Ⅲ/Ⅳ）(OR=2.371, 95% CI: 1.043～5.389, P=0.039), hernia sac diameter ≥5 cm（OR=2.815, 95% CI: 1.259～6.291, P=0.012）, and elevated NEU/ALB ratio（OR=3.821, 95% CI: 2.484～5.878, P<0.001） as independent risk factors for seroma. The risk prediction model was formulated as follows: Logit（P） =-3.490 +（Anticoagulant Use × 0.856） +（Hernia Type × 0.863） +（Hernia Sac Diameter × 1.035） +（NEU/ALB ratio × 1.341）. The area under the ROC curve（AUC） was 0.867, with a sensitivity of 80.80% and a specificity of 77.90%. The model demonstrated good fit upon internal validation using bootstrap resampling 1000 repetitions) and the Hosmer-Lemeshow test（χ2=6.672, P=0.572） indicated good model fit, with the prediction curve closely aligning with the ideal calibration curve. Conclusion The nomogram model developed in this study, incorporating NEU/ALB and clinical features, demonstrates good predictive capability for seroma formation in patients undergoing TAPP, which may assist in the preoperative identification of high-risk individuals. |
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