经腹腔镜逆行胆囊切除术治疗复杂胆囊结石中转开腹的预测列线图的构建与验证  

Construction and validation of a predictive nomogram for conversion to laparotomy in the treatment of complicated gallbladder stones via laparoscopic retrograde cholecystectomy

作　　者：马晓光 孙君儒 王晓[1] 李连生[1] 高军林[1] MA Xiaoguang;SUN Junru;WANG Xiao;LI Liansheng;GAO Junlin(Department of Hepatobiliary Pancreatic Hernia Surgery,Qinghai Red Cross Hospital,Xining,Qing-hai 810000,China)

机构地区：[1]青海红十字医院肝胆胰疝外科,青海西宁810000

出　　处：《安徽医药》2024年第1期74-79,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨经腹腔镜逆行胆囊切除术(laparoscopic retrograde cholecystectomy,LRC)治疗复杂胆囊结石(complicated gall-bladder stones,CGS)中转开腹的相关危险因素,构建预测列线图并进行验证。方法选取2016年9月至2019年3月青海红十字医院行LRC治疗CGS的病人380例作为训练集,2019年4月至2021年9月该院行LRC治疗CGS的病人350例作为验证集,训练集依据术中是否中转开腹分为中转组(34例)和非中转组(346例)。单因素分析两组病人的临床病理特征,logistic多元回归模型分析经LRC治疗CGS中转开腹的危险因素,基于该多因素logistic回归模型,构建中转开腹的列线图,并对其进行外部验证以及绘制校正曲线。结果训练集与验证集两组一般资料比较,各临床因素组间均差异无统计学意义(P>0.05);单因素分析显示训练集中中转组与非中转组在身体质量指数(body mass index,BMI)、上腹部手术史、糖尿病、胆囊颈结石、胆囊增大、胆囊炎发作时间、胆囊壁增厚、结石数量、白蛋白、白细胞计数(white blood cell count,WBC)及血清总胆红素(total bilirubin,TBiL)方面差异有统计学意义(均P<0.05),其中白蛋白<35 g/L比例更高(47.06%比29.77%)、WBC≥15×10^(9)/L比例更高(61.76%比43.06%)、TBiL>17.1μmol/L比例更高(73.53%比54.05%);logistic多元回归模型分析结果表明BMI、上腹部手术史、胆囊颈结石、胆囊炎发作时间、胆囊壁增厚、WBC以及白蛋白是经LRC治疗CGS中转开腹的独立危险因素(均P<0.05);关于这7项独立危险因素,建立风险列线图预测模型,并进行外部验证,训练集受试者操作特征(ROC)曲线下面积为0.89,95%CI为(0.83,0.92),验证集ROC曲线下面积为0.88,95%CI为(0.81,0.89),Hosmer-Lemeshow检验结果提示该预测模型具有良好稳定性。结论构建的LRC治疗CGS中转开腹的列线图,具有较高的风险预测精准度,在临床应用方面指导价值较高。Objective To investigate the risk factors for conversion to laparotomy in the treatment of complicated gallbladder stones(CGSs)by laparoscopic retrograde cholecystectomy(LRC)and to construct and validate a predictive nomogram.Methods A total of 380 patients who underwent LRC for the treatment of CGS in Qinghai Red Cross Hospital from September 2016 to March 2019 were selected as the training set,and 350 patients who underwent LRC for the treatment of CGS in this hospital from April 2019 to September 2021 were used as the validation set.The training set was divided into a conversion group(34 cases)and a nonconversion group(346 cases)according to whether conversion to laparotomy was performed during surgery.Univariate analysis of the clinicopathological characteristics of the two groups of patients and logistic multiple regression model analysis of the risk factors for conversion to laparotomy in CGS treated by LRC.Based on the multivariate logistic regression model,a nomogram of the transfer to laparotomy was constructed and externally verified,and a calibration curve was drawn.Results Comparison of general information between the training set and validation set groups showed no statistically significant differences between groups for any of the clinical factors(P>0.05).Univariate analysis showed that there were statistically significant differences in body mass index(BMI),history of upper abdominal surgery,diabetes mellitus,gallbladder wall thickening,gallbladder enlargement,cholecystitis attack time,gallbladder neck stones,number of stones,albumin(ALB),white blood cell count(WBC),and total bilirubin(TBiL)between the transit group and the nontransit group(P<0.05).The proportion of albumin<35 g/L was higher(47.06%vs.29.77%),the proportion of WBC≥15×10^(9)/L was higher(61.76%vs.43.06%),and the proportion of TBiL>17.1μmol/L was higher(73.53%vs.54.05%).Multivariate logistic regression analysis showed that BMI,history of upper abdominal surgery,gallbladder neck stones,duration of cholecystitis episodes,gallbladder

关 键 词：胆囊切除术 腹腔镜 中转开腹手术 胆囊结石病 血清白蛋白 身体质量指数 列线图 预测 验证 

分 类 号：R657.4[医药卫生—外科学]