关键词: 直肠癌, 腹腔镜术, 排尿功能障碍, 危险因素, 列线图预测模型

Abstract: Objective To explore the influencing factors of urinary dysfunction in patients with rectal cancer after laparoscopic surgery,and to construct and validate a column chart prediction model.Methods A retrospective analysis was conducted on the clinical data of 415 rectal cancer patients in our hospital from January 2021 to April 2024.According to the computer-generated allocation order,they were stochastically grouped into a modeling group of 311 cases and a validation group of 104 cases in a 3∶1 ratio.The modeling group was further separated into a urinary dysfunction group of 55 cases and a non urinary dysfunction group of 256 cases.The patient's sex, diabetes history, tumor diameter and other relevant data were collected; Multivariate-Logistic-regression analysis was used to screen for risk factors; R software was used to construct a column chart prediction model for predicting urinary dysfunction in patients with colorectal cancer after laparoscopic surgery; The Hosmer-Lemeshow test, ROC curve, calibration curve, and DCA curve were used to validate the predictive performance of the column chart model.Results Male [OR (95% CI)=3.512 (1.637~7.533), P=0.001], diabetes [OR (95% CI)=3.684 (1.639~8.280), P=0.002], tumor diameter ≥ 5 cm [OR (95% CI)=4.459 (1.993~9.979), P=0.000], large intraoperative bleeding [OR (95% CI)=1.018 (1.011~1.026), P=0.000], anterior resection of rectum combined with abdominal perineum resection [OR (95% CI)=3.885 (1.901~7.940), P=0.000] were Independent risk factors for postoperative urination dysfunction in rectal cancer patients after laparoscopic surgery.In internal and external validations,the Hosmer-Lemeshau test for the column chart model showed χ2=0.159,P=0.254>0.05,and χ2=5.991,P=0.648>0.05.The areas under the receiver operating characteristic curve were 0.846 and 0.828,respectively.The calibration curve indicated that the simulated curve had a similar trend to the actual curve,indicating good discrimination and calibration of the column chart prediction model.Clinical decision curve analysis results showed that when the high-risk threshold probability was between 0.05 and 0.98,the column chart prediction model could produce better clinical benefits.Conclusion The column chart model constructed by integrating independent risk factors for urinary dysfunction in rectal cancer patients after laparoscopic surgery has high predictive value.

Key words: rectal cancer, laparoscopic surgery, urinary dysfunction, risk factors, column chart prediction model