腹腔镜下胆总管切开取石术患者术后结石复发的相关危险因素及预测模型  

Risk factors and prediction model of stone recurrence in patients afterlaparoscopic common bile duct exploration

作　　者：李春林 冷书生 雷林平 李锋[1] 赵明英 LI Chunlin;LENG Shusheng;LEI Linping;LI Feng;ZHAO Mingying(Department of Hepatobiliary-Pancreatic-Splenic Surgery,The Affiliated Hospital of Chengdu University,Chengdu 610086,China;Department of Hepatic Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]成都大学附属医院肝胆胰脾外科,四川成都610086 [2]四川大学华西医院肝脏外科,四川成都610041

出　　处：《西部医学》2024年第7期1026-1030,共5页Medical Journal of West China

基　　金：四川省卫生健康委员会科研项目(21PJ185)。

摘　　要：目的探讨腹腔镜下胆总管切开取石术患者术后结石复发的相关危险因素并构建预测模型。方法选取2020年1月—2022年3月成都大学附属医院收治的102例腹腔镜下胆总管切开取石术患者作为研究对象,根据患者术后复发与否分为复发组(n=21)与未复发组(n=81),统计两组患者临床资料并采用Logistic回归模型分析患者术后结石复发相关危险因素,采用Homser-Lemeshow检验模型拟合优度,绘制受试者工作特征(ROC)曲线分析该模型预测效能。结果两组年龄、高血脂、结石数量、胆总管扩张、胆囊管扩张比较,差异有统计学意义(P<0.05),其余一般资料、结石及手术情况比较,差异无统计学意义(P>0.05);Logistic多因素模型分析结果表明高血脂、胆囊管扩张为影响患者术后结石复发的危险因素(P<0.05);依据Logistic多因素回归模型分析结果构建预测模型,lnλ(t)/λ0(t)=7.399+0.793×年龄+0.975×高血脂+0.965×结石数量+0.835×胆总管扩张+1.043×胆囊管扩张;Homser-Lemeshow检验拟合优度χ2=4.689,P=0.790;预测模型预测患者术后结石复发的曲线下面积(AUC)为0.801(0.710~0.873),Z=5.463、P<0.001,以0.253为截断值,其预测患者结石复发的敏感度、特异度分别为71.43%、81.48%。结论高血脂症、胆囊管扩张为腹腔镜下胆总管切开取石术患者术后结石复发的相关危险因素,且依据危险因素构建的预测模型对术后结石复发有良好的预测效能,值得临床重视。Objective To explore the risk factors of stone recurrence in patients after laparoscopic common bile duct exploration,and construct the prediction model.Methods A total of 102 patients who underwent laparoscopic common bile duct exploration in Affiliated Hospital of Chengdu University from January 2020 to March 2022 were selected as the study subjects.According to the ERCP Diagnosis and Treatment Guidelines(2018),the patients were divided into recurrence group(21 cases)and non-recurrence group(81 cases).Clinical data of the two groups of patients were statistically analyzed.Logistic regression model was used to screen the risk factors for postoperative stone recurrence.The model's goodness of fit was detected by Homser-Lemeshow test,and its predictive efficiency was analyzed using the receiver operating characteristic(ROC)curves.Results There were significant differences in age,hyperlipidemia,number of stones,common bile duct dilatation and gallbladder duct dilatation between the two groups(P<0.05),but there was no significant difference in the other general data,stones or surgical conditions(P>0.05).The results of Logistic multivariate model analysis showed that hyperlipidemia and gallbladder duct dilation were risk factors of postoperative stone recurrence(P<0.05).The prediction model was as follow:lnλ(t)/λ0(t)=7.399+0.793×age+0.975×hyperlipidemia+0.965×number of stones+0.835×common bile duct dilatation+1.043×gallbladder duct dilatation.The goodness of fit by Homser-Lemeshow test was as follow:χ2=4.689,P=0.790.The area under the ROC curve(AUC)of the prediction model for predicting postoperative stone recurrence was 0.801(0.710-0.873)(Z=5.463,P<0.001).Taking 0.253 as the cut-off value,sensitivity and specificity of the prediction model were 71.43%and 81.48%,respectively.Conclusion Hyperlipidemia and gallbladder duct dilatation are risk factors of stone recurrence in patients after laparoscopic common bile duct exploration.The prediction model based on risk factors has good predictive efficiency for posto

关 键 词：胆总管结石 腹腔镜 胆总管切开取石术 复发 危险因素 预测模型 

分 类 号：R657.42[医药卫生—外科学]