急性结石性胆囊炎行腹腔镜胆囊切除术后并发症的危险因素分析及风险预测模型的建立  

Risk factors analysis and risk prediction model establishment of complications after laparoscopic cholecystectomy for acute calculous cholecystitis

作　　者：汪昱[1] 徐建明[1] 莫玲斐 WANG Yu;XU Jianming;MO Lingfei(Department of Hepatobiliary Surgery,Chongzhou People's Hospital,Chengdu,Sichuan 611230,China)

机构地区：[1]崇州市人民医院肝胆外科,四川成都611230

出　　处：《安徽医药》2022年第10期2068-2071,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的分析急性结石性胆囊炎病人行腹腔镜胆囊切除术后发生并发症的危险因素,并建立风险预测模型。方法分析崇州市人民医院肝胆外科2018年1月至2020年1月220例行腹腔镜胆囊切除急性结石性胆囊炎病人,单因素和多因素分析急性结石性胆囊炎病人行腹腔镜胆囊切除术后发生并发症的危险因素,并建立风险预测模型。结果并发症组医师熟练程度≥200例的为60.87%(14/23);非并发症组医师熟练程度≥200例的为31.98%(63/197),并发症组合并急性炎症的为65.22%(15/23);非并发症组合并急性炎症的为35.03%(69/197),并发症组胆囊壁厚度>5 cm的为65.22%(15/23);非并发症组胆囊壁厚度>5 cm的为30.96%(61/197),并发症组胆囊三角变异的为43.48%(10/23);非并发症组胆囊三角变异的为18.78%(37/197),并发症组腹部手术史的为43.48%(10/23);非并发症组腹部手术史的为21.83%(43/197),医师熟练程度、合并急性炎症、胆囊壁厚度>5 mm、胆囊三角变异、腹部手术史是急性结石性胆囊炎病人行腹腔镜胆囊切除术后发生并发症的独立危险因素,基于此五项危险因素建立风险预测模型,并验证该列线图模型,实际值和预测值大小基本相近,C-index指数为0.89[95%CI:(0.87,0.92)],表明该风险预测模型的区分度和精准度较好。结论医师熟练程度、合并急性炎症、胆囊壁厚度>5 mm、胆囊三角变异、腹部手术史是急性结石性胆囊炎病人行腹腔镜胆囊切除术后发生并发症的独立危险因素,建立的风险预测列线图模型具有较高的精准度和区分度,有一定的临床指导意义。Objective To analyze the risk factors for complications after laparoscopic cholecystectomy in patients with acute calculous cholecystitis and to establish a risk prediction model.Methods Analysis was made of 220 patients with acute calculous cholecystitis who underwent laparoscopic cholecystectomy from January 2018 to January 2020 in the Department of Hepatobiliary Surgery of Chongzhou People's Hospital.Univariate and multivariate analysis of risk factors for complications after laparoscopic cholecystectomy in patients with acute calculous cholecystitis were performed and a risk prediction model was built.Results In the complication group,60.87%(14/23)of the doctors were proficient in more than or equal to 200 cases;In the non-complication group,31.98%(63/197)were proficient in more than or equal to 200 cases.In the complication group 65.22%(15/23)had a complication of acute inflammation,while in the non-complication group 35.03%(69/197)had a complication of acute inflammation.In the complication group 65.22%(15/23)had a gallbladder wall thickness more than 5 cm,while in the non-complication group 30.96%(61/197)had a gallbladder wall thickness more than 5 cm.gallbladder triangle variation was found in 43.48%(10/23)of the complication group and 18.78%(37/197)of the non-complication group.In the complication group,43.48%(10/23)had abdominal surgery history;In the non-complication group,21.83%(43/197)had a history of abdominal surgery.The doctor's proficiency,complicated acute inflammation,gallbladder wall thickness more than 5 cm,gallbladder triangle variation,and abdominal surgery history were independent risk factors for complications after laparoscopic cholecystectomy in patients with acute calculous cholecystitis.A risk prediction model was established based on these five risk factors,and the nomogram model was verified.The actual value and the predicted value were basically similar,the C-index was 0.89[95%CI:(0.87,0.92)],indicating that the discrimination and accuracy of the risk prediction model were good.Con

关 键 词：胆结石 胆囊炎 急性 腹腔镜胆囊切除术 危险因素 风险预测模型 

分 类 号：R657.4[医药卫生—外科学]