北京大学学报（医学版）2024，Vol.56Issue(4)：646-655,10.DOI:10.19723/j.issn.1671-167X.2024.04.017
构建显微精索手术治疗精索疼痛的术后疼痛缓解预测模型
Construction of a predictive model for postoperative pain relief after microscopic spermatic cord surgery for spermatic cord pain
摘要
Abstract
Objective:To explore the relevant factors affecting the efficacy of microscopic spermatic cord surgery and build a predictive model for postoperative pain relief.Methods:A retrospective analysis was conducted on the clinical data of 324 patients with spermatic cord pain who visited the Department of Urology at Peking University People's Hospital between October 2015 and April 2023.This cohort included 212 patients with varicocele-related spermatic cord pain and 112 patients with idiopathic sper-matic cord pain.All the patients underwent microsurgical procedures:varicocele-related pain was treated with microsurgical varicocelectomy,and idiopathic pain was treated with microsurgical denervation of the spermatic cord.The patients were categorized into effective and ineffective groups based on whether their pain had decreased by more than 50％six months post-surgery compared with pre-surgery levels.Base-line data were preliminarily screened for clinical indicators using t tests and univariate analysis.Clinical predictor variables[age,duration of pain,diameter of varicocele,patient health questionnaire-9(PHQ-9)score,generalized anxiety disorder-7(GAD-7)score]were selected using Lasso regression.Aclini-cal prediction model for effective pain relief following microscopic spermatic cord surgery was constructed using Logistic regression and presented as a nomogram.The model's internal validation was performed using the bootstrap method.Its predictive power and clinical utility were evaluated through the concor-dance index,the area under the receiver operating characteristic curve,and calibration plots.Results:Post-microscopic varicocele ligation,156 patients(73.58％)experienced significant pain relief,as did 94 patients(83.93％)following microscopic denervation.Independent predictors for postoperative out-comes included age,PHQ-9 score,GAD-7 score,chronic pain duration,and varicocele diameter,diffe-ring slightly between varicocele-related and idiopathic pain groups.The models demonstrated excellent predictive ability,with areas under the curve of 0.909 and 0.913 for varicocele and idiopathic groups,respectively,and high concordance indices.Conclusion:The postoperative efficacy prediction model based on age,pain duration,PHQ-9 score,GAD-7 score,and varicocele diameter has good predictive ability and clinical applicability,and can be used in clinical practice.关键词
精索/疼痛/精索静脉曲张/去神经支配/预测模型Key words
Spermatic cord/Pain/Varicocele/Denervation/Predictive model分类
医药卫生引用本文复制引用
何海龙,李清,徐涛,张晓威..构建显微精索手术治疗精索疼痛的术后疼痛缓解预测模型[J].北京大学学报（医学版）,2024,56(4):646-655,10.基金项目
北京市自然科学基金(7194327)Supported by the Beijing Natural Science Foundation(7194327) （7194327）
