探究个体化预测腹腔镜下儿童斜疝疝囊高位结扎术后复发的风险预测模型的建立。

收集2017年10月至2019年10月于新疆医科大学第一附属医院行腹腔镜疝囊高位结扎术的腹股沟斜疝194例患儿的临床资料。基于是否复发将患儿分为复发组（31例）和未复发组（163例），复发组患儿均采取开放式疝囊高位结扎术进行二次手术治疗。采用单因素和Logistic回归多因素分析术后复发的危险因素，并建立相关列线图模型。

单因素分析显示：2组性别、病程、是否合并隐匿疝、有无嵌顿疝、是否疝环粘连、发病部位、疝囊大小资料间差异无统计学意义（P>0.05）。2组年龄、小儿肥胖症、内环口大小和结扎线类型间差异有统计学意义（P<0.05）。多因素分析显示：年龄≥6岁、小儿肥胖症、内环口大小≥3 cm、可吸收线结扎是腹腔镜下儿童斜疝疝囊高位结扎术后复发的独立危险因素（P<0.05）。模型验证结果显示：C-index为0.744，校准曲线趋近于理想曲线，表明具有良好的预测精度，受试者工作特征曲线下面积为0.760（95% CI：0.715~0.803），表明具有良好的区分度。

临床应对年龄≥6岁、小儿肥胖症、内环口大小≥3 cm、可吸收线结扎的腹股沟斜疝患儿予以重视，警惕其在腹腔镜下疝囊高位结扎术后出现复发，据此建立的列线图模型能够有效预测腹腔镜下儿童斜疝疝囊高位结扎术后的复发风险。

To explore the establishment of an individualized prediction model for the risk of recurrence after laparoscopic high ligation of indirect hernia sac in children.

The clinical data of 194 children with indirect inguinal hernia who underwent laparoscopic high ligation of hernia sac in the First Affiliated Hospital of Xinjiang Medical University from October 2017 to October 2019 were collected. The children were divided into recurrence group (31 cases) and no recurrence group (163 cases) based on whether they had recurrence. All children in the recurrence group were treated with a second open high ligation of hernia sac. The risk factors of postoperative recurrence were analyzed using univariate analysis and multivariate logistic regression, and the related nomogram model was established.

Univariate analysis showed that there was no significant difference between the two groups in sex, course of disease, occult hernia, incarcerated hernia, hernia ring adhesion, location of disease and hernia sac size (P>0.05). There were significant differences in age, childhood obesity, inner ring size and ligation suture type between the two groups (P<0.05). Multivariate analysis showed that age ≥6 years old, childhood obesity, internal ring size ≥3 cm and absorbable suture ligation were independent risk factors for recurrence after laparoscopic high ligation of indirect hernia sac in children (P<0.05). The model verification results show that the C-index is 0.744, the correction curve is close to the ideal curve, indicating a good prediction accuracy. The area under the ROC curve is 0.760 (95% CI: 0.715-0.803), indicating good discrimination.

Attention should be paid to children with indirect inguinal hernia who aged ≥6 years, with obesity, whose inner ring size is ≥3 cm and who had absorbable suture ligation. They should be vigilant about their recurrence after laparoscopic high ligation of hernia sac. The nomogram model can effectively predict the risk of recurrence after laparoscopic high ligation of indirect hernia sac in children.