摘要
目的探讨外伤导致的尿道球部、膜部狭窄患者行经会阴人路尿道重建术后狭窄复发的危险因素,构建预测术后复发的列线图模型。方法回顾性分析2016年1月至2017年12月四川大学华西医院收治的因外伤导致尿道球部或膜部狭窄的78例患者的病例资料,所有患者均接受经会阴入路尿道重建术。术后随访期间尿道狭窄复发13例(复发组),无尿道狭窄复发65例(未复发组)。复发组年龄(49.8±12.0)岁,3例合并糖尿病,9例有吸烟史;8例术前有泌尿系统感染;4例术前有尿道扩张史;术前血清总蛋白含量(67.80±1.18)g/L;10例为尿道膜部狭窄,7例狭窄尿道近端位于耻骨上缘以上(高位狭窄);术中测量狭窄长度为(2.19±0.22)cm。未复发组年龄(44.8±13.6)岁,3例合并糖尿病,25例有吸烟史;37例术前有泌尿系统感染;4例术前有尿道扩张史;术前血清总蛋白含量(71.83±0.70)g/L;38例为尿道膜部狭窄,14例为高位狭窄;术中测量狭窄长度为(2.03±0.11)cm。采用单因素、多因素logistics回归分析术后5年尿道狭窄复发的危险因素,构建预测复发的列线图模型,并评估模型的区分度和准确性。结果单因素分析结果显示,吸烟史(P=0.050)、糖尿病史(P=0.039)、术前尿道扩张史(P=0.016)、术前血清总蛋白含量(P=0.023)、高位狭窄(P=0.031)与术后尿道狭窄复发相关。多因素分析结果显示,高位狭窄(0R=34.64,95%CI3.71~754.53,P=0.007)、术前尿道扩张史(0R=13.15,95%CI 1.27~210.00,P=0.041)、吸烟(0R=13.75,95%CI2.15~166.05,P=0.015)、糖尿病(0R=64.98,95%CI3.80~1957.60,P=0.007)是尿道狭窄复发的独立危险因素,较高的血清总蛋白含量与更低的复发风险相关(0R=0.78,95%CI0.62~0.93,P=0.013)。根据多因素回归分析结果构建预测狭窄复发风险的列线图,预测模型的C-index为0.923(95%CI0.908~0.938),受试者工作特征曲线下面积为0.923(95%CI0.855~0.991),截断点对应的特异性为87.7%,敏感性为84.6%;布里尔分数为0.079。结论狭窄尿道近端位于耻骨支上缘以上、术前尿道扩张史、吸烟、糖尿病是外伤导致的尿道球部、膜部狭窄行经会阴入路尿道重建术后狭窄复发的独立危险因素,较高的血清总蛋白含量可能具有潜在保护作用。利用上述危险因素构建的列线图可预测术后狭窄复发的风险。
Objective To explore the risk factors for urethral stricture after transperineal anastomotic urethroplasty(TAU)by retrospectively analyzing patient data and to develop a nomogram to predict the risk of recurrence before the surgery.Methods Clinical data of patients who underwent TAU because of post-traumatic urethral stricture from January 2016 to December 2017 in West China Hospital,Sichuan University were reviewd.A total of 78 patients were included in the retrospective analysis,with 13 of them having recurrence.The patients in the recurrence group had a median age of 49.8 and 76.9%(10/13)of them had membranous urethral stricture.The proximal urethra end was located above the superior margin of the pubic ramus(higher stricture site)in 53.8%(7/13)of patients in the recurrence group and the length of the stricture measured in the operation was(2.19±0.22)cm.In the non-recurrence group,the median age was(44.8±13.6)years old,58.5%(38/65)of them had membranous urethral stricture,21.5%(14/65)had higher stricture site,and the length of the stricture was(2.03±0.11)cm.Both univariate and multivariate logistics analyses were performed to evaluate the risk factors of recurrence of urethral stricture 5 years after surgery.The nomogram was built based on the multivariate logistics analysis.The Concordance Index(C-index),Receiver Operating Characteristic(ROC)curve and Calibration curve were used to evaluate the nomogram.Results Univariate logistics analysis showed that higher stricture site,history of urethral dilation,smoking,diabetes and total serum protein may be associated with recurrence after surgery.Multivariate logistics analysis further confirmed that higher stricture site(OR=34.64,95%CI 3.71-754.53),history of urethral dilation(0R=13.15,95%CI 1.27-210.00),smoking(OR=13.75,95%CI 2.15-166.05)and diabetes(0R=64.98,95%CI 3.80-1957.60)were independent risk factors for recurrent urethral stricture while higher total serum protein before surgery was related to lower recurrence risk(OR=0.78,95%CI 0.62-0.93).A nomogram was built based on the results.The C-index of the nomogram was 0.923(95%CI 0.908-0.938),the area under curve(AUC)was 0.923(95%CI 0.855-0.991),and the Brier Score was 0.079.Conclusion Higher stricture site,history of urethral dilation before surgery,smoking,diabetes and lower total serum protein before surgery are associated with higher recurrence TAU of post-traumatic urethral stricture patients.With the nomogram developed,prediction of the risk of recurrence could be achieved prior surgery.
作者
李雅
廖邦华
周亮
马玉成
王坤杰
Li Ya;Liao Banghua;Zhou Liang;Ma Yucheng;Wang Kunjie(Department of Urology,Institute of Urology(Laboratory of Reconstructive Urology),West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2023年第8期571-576,共6页
Chinese Journal of Urology
关键词
尿道狭窄
复发
预测
修复外科手术
Urethral stricture
Recurrence
Forecasting
Reconstructive surgical procedures
