RESUMO
Objective:To explore the influencing factors of postoperative recurrence in patients with complex anal fistula, and to construct a nomogram model to predict the risk of postoperative recurrence and verify it.Methods:Clinical data of 310 patients with complex anal fistula who underwent fistulectomy in the hospital from Aug. 2019 to Mar. 2023 were retrospectively selected and divided into modeling group (93 cases) and validation group (217 cases) in a 3∶7 ratio according to system randomization method. Hospital electronic medical record system was used to collect patient baseline data and calculate the recurrence rate of patients 6 months after surgery. According to the data of the modeling group, multivariate Logistic regression was used to analyze the influencing factors of postoperative recurrence in patients with complex anal fistula. Based on the influencing factors, a nomogram model was established to predict the risk of postoperative recurrence, and external verification was performed based on the data of the validation group.Results:The recurrence rate at 6 months after operation was 20.43% (19/93) in the modeling group and 17.51% (38/217) in the validation group. There was no significant difference in recurrence rate between the two groups ( χ2=0.370, P=0.543) . The proportion of male, smoking history, diabetes mellitus, high anal fistula and unclear position of internal orifice in the recurrence group was higher than that in the non-recurrence group, and the body mass index and course of disease were higher than those in the non-recurrence group ( P<0.05) . Based on the above seven influencing factors, a nomogram model of the risk of recurrence of complex anal fistula after surgery was established. C index of the modeling group and the validation group was 0.984 and 0.798 respectively, the calibration curve was close to the ideal curve, and the Receiver operating characteristic AUC of the nomogram prediction model was>0.70, indicating that model consistency, prediction efficiency and differentiation were good. Conclusion:The nomogram prediction model based on gender, body mass index, smoking history, diabetes mellitus, course of disease, high anal fistula and internal orifice position can effectively predict the risk of postoperative recurrence in patients with complex anal fistula.
RESUMO
Objective To determine the normal value and clinical significance of the lengths and angles of both mandible and hyoid, and their relationship with cervical vertebra as well as the transverse area of the airway at the hyoid level using CT. Methods Several lines and angles on the CT images were measured in 68 normal subjects. Line A was the length between both free ends of the mandible; line B was the distance from the body of the mandible to line A; Line C was the distance from line A to the anterior aspect of the cervical vertebra. ?1 was the angle between the middle of mandible body and its two free ends. Line a was the distance between two free ends of greater horn of hyoid bone. Line b was the distance from hyoid to line a. line c was the distance from line a to the cervical vertebra ?2 was the angle between the middle of hyoid body and its two free ends. S stood for the area of the airway at the hyoid level. SPSS 11.5 statistical analysis package was used to analyze the results. Results The average and median distance/angle of various measurements were as follows: bne A was (89. 28?5. 90) mm and 88. 70 mm, line B was (62. 61?5. 78) mm and 62. 50 mm, line C was (9. 29?3. 29) mm and 4. 20 mm, ?1 was (71. 25? 6. 77)? and 71. 05? , line a was (38. 69?6. 07) mm and 39. 90 mm, line b was (28. 79?4. 37) mm and 28.50mm, line c was (1.91?3.03) mm and 1.75 mm, ?2 was (68.47?15.71)? and 66.95?.The average S was (436. 14?160. 37) mm and median was 431. 75mm2. Conclusion It's easy to measure the three lines and the two angles of mandible and hyoid. The measurement is of vital importance in the diagnosis and treatment for obstructive sleep apnea syndrome.
