【摘要】 目的 探讨腹膜外引流对腹腔镜辅助下腹部正中手术切口并发症的影响，分析切口并发症相关危险因素并构建预测模型。方法 2017年1月～2023年9月采用腹腔镜手术的结直肠恶性肿瘤病人200例，均采用腹腔镜辅助下腹部正中切口。根据术中是否将负压引流管置于腹膜外层，分为腹膜外负压引流管组(120例)和未置负压引流管组(80例)。收集两组病人一般资料、术中及术后资料。采用单因素及多因素Logistic回归模型分析腹腔镜辅助下腹部正中切口并发症的影响因素，构建预测模型。按照同样的标准收集2023年10月～2025年1月结直肠恶性肿瘤病人63例作为外部验证组。在建模及外部验证组中均通过C-index、受试者工作特征(ROC)曲线、校准曲线、决策曲线来评估预测模型效果。结果 两组病人一般资料及术中资料比较，差异无统计学意义(P>0.05)。单因素及多因素Logistic回归分析显示，腹膜外放置负压引流使手术部位感染(surgical site infections, SSIs)率绝对风险降低6.7%,相对风险降低53.6%;合并糖尿病、既往腹部手术史、腹腔粘连、肠造口术是SSIs及脂肪液化的危险因素(P<0.05)。在建模及外部验证组中，SSIs模型的C-index为0.857,95%CI 0.749～0.966、0.959,95%CI 0.909～1.008;脂肪液化模型为0.868,95%CI 0.797～0.939、0.955,95%CI 0.895～1.016。SSIs模型的ROC曲线下面积(AUC)为0.865,95%CI 0.756～0.975、0.967,95%CI 0.914～1.000;脂肪液化模型为0.876,95%CI 0.803～0.948、0.964,95%CI 0.904～1.000。两个模型的校准曲线均通过Spiegelhalter检验(P>0.05)。两个模型的临床决策曲线均表现出较高的阈值范围。结论 糖尿病、既往腹部手术史、腹腔粘连、肠造口术是SSIs及脂肪液化的危险因素，对于使用腹腔镜辅助下腹正中切口行手术治疗的结直肠恶性肿瘤病人，建议行腹膜外引流预防切口感染；两个列线图模型能够较准确地预测术后发生SSIs与脂肪液化的风险。更多还原

【Abstract】 Objective To investigate the effect of extraperitoneal drainage on incisional complications of laparoscopic-assisted median abdominal surgery.The risk factors related to incisional complications were also analysed separately and a prediction model was constructed.Methods Retrospective analysis included 200 patients with colorectal malignant tumours who were operated with laparoscopy from January 2017 to September 2023 at the Department of Abdominal Oncology of the People’s Hospital of the Inner Mongolia Autonomous Region(all of whom were operated using laparoscopically-assisted median incision of the lower abdomen),and were divided into the group of extra-peritoneal negative pressure drain(120 cases) and the group of no negative pressure drain(80 cases),according to whether or not negative pressure drains were placed on the outer layer of the peritoneum intraoperatively.General, intraoperative and postoperative data of patients in the two groups were collected and analysed.Single-factor and multifactor Logistic regression models were used to analyse the influencing factors of laparoscopically assisted median abdominal incision complications, analyse the risk factors related to incision complications, and construct a prediction model.Sixty-three patients with colorectal malignancy in our department from October 2023 to January 2025 were collected as an external validation group according to the same criteria.The predictive model effect was assessed by C-index,receiver operating characteristic(ROC) curve, calibration curve, and decision curve in both modelling and external validation groups.Results There was no statistically significant difference between the two groups when comparing the general and intraoperative data(P>0.05).The results of univariate and multivariate Logistic regression analysis showed that extraperitoneal placement of negative pressure drainage reduced the absolute risk of surgical site infections(SSIs) rate by 6.7% and the relative risk by 53.6%;patients’ combination of diabetes mellitus, history of previous abdominal surgeries, abdominal adhesions, and intestinal stomas were the risk of SSIs and fatty liquefaction factors(P<0.05).In the modelling and external validation groups, the C-index of the SSIs model was 0.857,95%CI 0.749 to 0.966,0.959,95% CI 0.909 to 1.008;and that of the fat liquefaction model was 0.868,95%CI 0.797 to 0.939,0.955,95%CI 0.895 to 1.016.The area under the ROC curve AOC of the SSIs The area under the ROC curve AUC for the model was 0.865,95%CI 0.756 to 0.975,0.967,95%CI 0.914-1.000,and for the fat liquefaction model was 0.876,95%CI 0.803 to 0.948,0.964,95%CI 0.904-1.000.The calibration curves of the two models passed the Spiegelhalter test(P>0.05).The clinical decision curve of both models showed a high threshold range.Conclusion Diabetes mellitus, history of previous abdominal surgery, abdominal adhesions, and enterostomy are risk factors for SSIs and fatty liquefaction, and for patients with colorectal malignancies treated with laparoscopically-assisted lower abdominal median incision, extraperitoneal drainage is recommended for the prevention of incisional infections; two columnar-line graphical models can more accurately predict the risk of SSIs and fatty liquefaction in the postoperative period, which has a certain clinical reference value.更多还原