摘要
Abstract
Objective To analyze the independent risk factors for abdominal distension in patients after radi-cal resection of colorectal cancer(CRC),establish a risk stratification model for postoperative abdominal disten-sion,formulate individualized preventive strategies,and provide evidence-based references for reducing the clinical incidence of postoperative abdominal distension.Methods A total of 132 patients who underwent radical resection of CRC in our hospital from January 2024 to December 2025 were retrospectively enrolled and divided into an abdominal distension group and a non-abdominal distension group according to the occurrence of postoperative abdominal distension.Differences in clinical data were compared between the two groups.Uni-variate analysis,LASSO regression and multivariate Logistic regression were adopted to screen independent risk factors for postoperative abdominal distension,and a risk nomogram model was constructed based on the identified risk factors.Bootstrap method was used for internal validation.C-index,calibration curve and deci-sion curve analysis were applied to evaluate the discrimination,calibration and clinical practicability of the model respectively,and targeted preventive strategies were formulated accordingly.Results There were statisti-cally significant differences in age,history of chronic constipation,surgical approach,operation duration,intra-operative blood loss,postoperative dosage of opioids,postoperative hypokalemia,postoperative fasting time and time to first ambulation between the two groups(P<0.05).LASSO-Logistic regression analysis revealed that age,open surgery,high-dose postoperative opioid administration,postoperative hypokalemia,postopera-tive fasting time≥48 h and time to first ambulation≥24 h were independent risk factors for abdominal disten-sion after radical resection of CRC(P<0.05).ROC curve analysis demonstrated that the area under the curve(AUC)(95%CI)of the nomogram model for predicting postoperative abdominal distension was 0.906(0.842-0.967),with a sensitivity of 90.80%and a specificity of 85.50%(P<0.001),indicating favorable predictive efficiency.The C-index obtained by Bootstrap internal validation was 0.889(95%CI 0.732-0.953).The calibration curve showed great consistency between predicted value and actual value.The Hosmer-Lemeshow goodness-of-fit test yielded χ²=2.106,P=0.598,suggesting satisfactory model fitting.Decision curve analysis presented positive net clinical benefit within the threshold probability range of 0%-85%,indicating a high clinical practical value.Conclusion Age,open surgery,high-dose use of postoperative opi-oid,postoperative hypokalemia,fasting time≥48 h and time to first ambulation≥24 h are independent risk factors for abdominal distension after radical resection of CRC.The nomogram model built on these factors exhibits excellent discrimination,calibration and clinical practicability,which can serve as a quantitative tool for clinicians to early identify high-risk patients and implement individualized preventive strategies.关键词
结直肠癌/术后/腹胀/影响因素/列线图模型/预防策略Key words
Colorectal cancer/Postoperation/Abdominal distension/Influencing factors/Nomogram model/Preventive strategies
