Bian FuCheng, Li KunShi, Bian GuangYu, Li XiuMei
Department of Endoscopic Diagnosis, Daqing Oilfield General Hospital, Heilongjiang, Daqing, 163000, China.
Department of Obstetrics, Daqing Oilfield General Hospital, Heilongjiang, Daqing, 163000, China.
Int J Colorectal Dis. 2024 Dec 12;39(1):200. doi: 10.1007/s00384-024-04783-9.
The aim of this study is to establish a nomogram that can predict the risk factors for delayed bleeding after endoscopic submucosal dissection (ESD). This model can be used to assess the probability of delayed bleeding before ESD surgery, thereby avoiding wasting medical resources and improving patient satisfaction.
This was a retrospective study in which all patients underwent ESD surgery for colorectal tumors between August 2021 and February 2024. Patient demographics and surgical characteristics were collected. All patients were randomly divided into a training set and a testing set. Univariate and multivariate regression analyses of the training set revealed the independent risk factors for delayed bleeding after ESD. These independent risk factors were used to construct a nomogram model. This model was validated using internal validation methods such as the C-index, calibration curve, and decision curve analysis.
This study included 587 patients. The occurrence rate of delayed bleeding after ESD in the training set was 8.98%. Multivariate regression analysis revealed that the location of the lesion in the rectum, a large lesion, and a prolonged surgery time were independent risk factors for delayed bleeding after ESD. The C-index for this model was 0.89, and validation of this nomogram model demonstrated good consistency between the predicted and actual values.
Multivariate regression analysis revealed the independent risk factors for delayed bleeding after ESD, and a nomogram with a relatively consistent accuracy was established. The clinical application of this model can reduce the incidence of delayed bleeding and therefore improve patient healing.
本研究的目的是建立一种能预测内镜黏膜下剥离术（ESD）后延迟出血风险因素的列线图。该模型可用于评估ESD手术前延迟出血的概率，从而避免医疗资源的浪费并提高患者满意度。
这是一项回顾性研究，纳入了2021年8月至2024年2月期间所有因结直肠肿瘤接受ESD手术的患者。收集患者的人口统计学资料和手术特征。所有患者被随机分为训练集和测试集。对训练集进行单因素和多因素回归分析，以揭示ESD后延迟出血的独立危险因素。这些独立危险因素被用于构建列线图模型。使用C指数、校准曲线和决策曲线分析等内部验证方法对该模型进行验证。
本研究共纳入587例患者。训练集中ESD后延迟出血的发生率为8.98%。多因素回归分析显示，病变位于直肠、病变较大以及手术时间延长是ESD后延迟出血的独立危险因素。该模型的C指数为0.89，对该列线图模型的验证表明预测值与实际值之间具有良好的一致性。
多因素回归分析揭示了ESD后延迟出血的独立危险因素，并建立了一个准确性相对一致的列线图。该模型的临床应用可降低延迟出血的发生率，从而促进患者康复。
