摘要
Abstract
Objective:To explore the influencing factors of postoperative urinary retention in patients with mixed hemorrhoids and construct a nomogram prediction model.Method:449 patients with mixed hemorrhoids who underwent surgical treatment from June 2021 to June 2025 in the 907th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army were included and randomly assigned into the training set(n=314)and the validation set(n=135)at a ratio of 7:3.According to the occurrence of postoperative urinary retention,the patients in the training set were further assigned into the non-occurrence group(n=258)and the occurrence group(n=56).Data such as anesthesia methods,the number of resected external hemorrhoids,and the postoperative 3 h Visual Analogue Scale(VAS)score were collected.Multivariate logistic regression analysis was used to screen for independent influencing factors of postoperative urinary retention in patients with mixed hemorrhoids in the training set,and a nomogram prediction model was constructed.The Bootstrap method was used to validate the nomogram prediction model,and the calibration curve,receiver operating characteristic(ROC)curve,and decision curve analysis(DCA)curve were respectively employed to evaluate the calibration,discrimination,and clinical applicability of the model.Result:There were no statistical differences in gender,age,disease duration and other data between the training set and the validation set(P>0.05).The occurrence group had higher proportions of constipation,epidural anesthesia,the number of resected external hemorrhoids≥3,pressure dressings,and the postoperative 3 h VAS score than the non-occurrence group,with statistically significant differences(P<0.05).Constipation,epidural anesthesia,the number of resected external hemorrhoids≥3,pressure dressings,and a higher postoperative 3 h VAS score were independent influencing factors for postoperative urinary retention in patients with mixed hemorrhoids(P<0.05).The calibration curve results of the training set and the validation set showed that the actual observed values were basically consistent with the predicted probabilities,and the Hosmer-Lemeshow goodness-of-fit test had χ2=7.178,0.645,P=0.518,0.813.The ROC curve results showed that the AUC values were 0.843(95%CI:0.784～0.903)and 0.823(95%CI:0.755～.891),respectively.The DCA curve results showed that when the risk threshold probability was within the range of 0.08～0.89 and 0.09～0.90,the clinical net benefit of the nomogram prediction model was relatively high.Conclusion:The nomogram developed in this study can effectively predict the risk of postoperative urinary retention in patients with mixed hemorrhoids.关键词
混合痔/术后尿潴留/影响因素/列线图/预测Key words
Mixed hemorrhoids/Postoperative urinary retention/Influencing factors/Nomogram/Prediction
