腹腔镜胆总管切开取石术联合腹腔镜胆囊切除术后结石复发的影响因素分析及风险预测模型的建立  

Analysis of factors influencing stone recurrence and establishment of risk prediction model after laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy

作　　者：张晓阳[1] 于瀚翔 温军业[1] 鲍文娟 徐行 时怡格 Zhang Xiaoyang;Yu Hanxiang;Wen Junye;Bao Wenjuan;Xu Xing;Shi Yige(Department of Hepatobiliary Surgery,Hebei General Hospital,Shijiazhuang 050057,China;Graduate School,North China University of Science and Technology,Tangshan 063210,China;Graduate School of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北省人民医院肝胆外科,石家庄050057 [2]华北理工大学研究生学院,唐山063210 [3]河北医科大学研究生学院,石家庄050011

出　　处：《中华肝胆外科杂志》2024年第10期766-770,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：河北省医学科学研究课题(20230416)。

摘　　要：目的探索腹腔镜胆总管切开取石术(LCBDE)联合腹腔镜胆囊切除术(LC)术后结石复发的危险因素,并建立风险预测模型。方法回顾性分析2016年1月至2022年3月在河北省人民医院行LCBDE联合LC的344例胆管结石患者的临床资料,其中男性165例,女性179例,年龄(62.72±13.56)岁。依据随访期内结石是否复发,将患者分为两组:复发组(n=37)和未复发组(n=307)。收集患者的胆总管直径、结石大小、结石数目、T管留置时间等临床资料。采用logistic回归分析术后结石复发的危险因素,建立logistic回归模型。受试者工作特征曲线下面积、Hosmer-Lemeshow拟合优度检验评估模型的预测效能。结果多因素logistic回归分析结果显示,胆总管结石数量≥2个(OR=3.094,95%CI:1.069~8.954,P=0.037)的胆管结石患者,LCBDE联合LC术后结石复发的风险高,而术后规律口服利胆药物(OR=0.160,95%CI:0.072~0.354,P=0.001)是LCBDE联合LC术后结石复发的保护因素。基于胆总管结石数量和术后口服利胆药物情况建立的logistic回归模型预测胆管结石患者LCBDE联合LC术后结石复发的受试者工作特征曲线下面积为0.821(95%CI:0.758~0.885)。经Hosmer-Lemeshow拟合优度检验,χ^(2)=7.26,P=0.509,提示该模型预测概率与理想概率之间具有良好的一致性。结论结石数量(≥2个)是胆管结石患者LCBDE联合LC术后结石复发的独立危险因素,术后规律口服利胆药物是LCBDE联合LC术后结石复发的保护因素。基于胆总管结石数量和术后口服利胆药物情况建立的预测模型对术后结石复发的预测效能较好。ObjectiveTo explore the risk factors for stone recurrence after laparoscopic common bile duct exploration(LCBDE)combined with laparoscopic cholecystectomy(LC)and to develop a risk prediction model.MethodsClinical data of 344 patients with bile duct stones who underwent LCBDE combined with LC at Hebei General Hospital from January 2016 to March 2022 were retrospectively analyzed,including 165 males and 179 females,aged(62.72±13.56)years old.Patients were divided into two groups based on whether stones recurred during the follow-up period:recurrence group(n=37)and non-recurrence group(n=307).Clinical data such as common bile duct diameter,stone size,number of stones and duration of T-tube drainage were collected from the patients.Logistic regression was used to analyze the risk factors for postoperative stone recurrence,and then developed a logistic regression model.The predictive efficacy of the model was assessed by the area under the receiver operating characteristic(ROC)curve,and the Hosmer-Lemeshow test.ResultsThe results of multifactorial logistic regression analysis showed that patients with≥2 choledochal stones had a high risk of stone recurrence after LCBDE combined with LC(OR=3.094,95%CI:1.069-8.954,P=0.037).In contrast,regular postoperative oral choleretic medication was a protective factor for stone recurrence after LCBDE combined with LC(OR=0.160,95%CI:0.072-0.354,P=0.001).A logistic regression model,based on the number of common bile duct stones and regular postoperative oral choleretic medication,was developed to predict the recurrence of bile duct stones in patients who underwent LCBDE combined with LC.The area under the ROC curve for this model was found to be 0.821(95%CI:0.758-0.885).The Hosmer-Lemeshow test,χ^(2)=7.26,P=0.509,suggested that there is good agreement between the model's predicted probabilities and ideal probabilities.ConclusionsThe number of stones(≥2)is an independent risk factor for stone recurrence after LCBDE combined with LC in patients with bile duct stones.Regular posto

关 键 词：胆石 腹腔镜胆总管探查术 复发因素 多因素分析 

分 类 号：R657.4[医药卫生—外科学]