肝胆管结石术后复发的预测模型的构建及评价  

Construction and evaluation of a predictive model for recur⁃rence of intrahepatic bile duct stones after surgery

作　　者：王斌 靳高超 管培 孔令新 史佳 WANG Bin;JIN Gao-chao;GUAN Pei;KONG Ling-xin;SHI Jia(Department of General Surgery,Linxi Hospital,Kailuan General Hospital,Tangshan 603100,China;Department of Hepatobiliary Surgery,Xingtai People's Hospital,Xingtai 054001,China;Department of Orthopaedics,the Fourth People's Hospital of Langfang,Langfang 065799,China;Department of Emergency Surgery,Ningjin Maternal and Child Health Hospital,Xingtai 055550,China;Department of General Surgery,Gaocheng People's Hospital of Shijiazhuang,Shijiazhuang 052160,China)

机构地区：[1]开滦总医院林西医院普通外科,河北唐山603100 [2]邢台市人民医院肝胆外科,河北邢台054001 [3]廊坊市第四人民医院骨科,河北廊坊065799 [4]宁晋县妇幼保健院急诊外科,河北邢台055550 [5]石家庄市藁城人民医院普外科,河北石家庄052160

出　　处：《中国现代普通外科进展》2024年第11期861-866,共6页Chinese Journal of Current Advances in General Surgery

基　　金：2024年度河北省医学科学研究课题计划(20241233)。

摘　　要：目的:基于临床资料和血清视黄醇结合蛋白4(RBP4)、胆囊收缩素A(CCK-A)构建肝胆管结石术后复发的预测模型及评价。方法:回顾性纳入2020年1月—2022年12月行腹腔镜联合胆道镜取石术的肝胆管结石患者135例,按照2∶1的比例分为建模集(n=90)和验证集(n=45)。患者术后随访1年,根据是否复发分为复发组、未复发组,单因素、Logistic回归分析患者术后复发的影响因素,根据影响因素构建列线图预测模型,用校准曲线、一致性指数、受试者工作特征(ROC)曲线、决策曲线进行内外部验证。结果:建模集中复发组双侧结石分布、最大结石直径≥10 mm、胆管狭窄、结石数目多发、乳头旁憩室比例及术后7 d血清RBP4水平高于未复发组,术后7 d血清CCK-A水平低于未复发组(P<0.05);最大结石直径≥10 mm、双侧结石分布、胆管狭窄、结石数目多发、乳头旁憩室、术后7 d血清RBP4水平、术后7 d血清CCK-A水平是肝胆管结石术后复发的影响因素(P<0.05);根据影响因素构建列线图预测模型,内外部验证显示,该预测模型具有良好的预测能力和临床净收益。结论:肝胆管结石手术后复发的影响因素包括术后7 d血清RBP4、CCK-A、双侧结石分布等,通过上述因素构建的列线图预测模型具有较高的预测价值和临床获益度。Objective:To construct and evaluate a predictive model for the recurrence of hepatolithiasis after surgery based on clinical data and serum retinol binding protein 4(RBP4)and cholecystokinin A(CCK-A).Methods:One hundred and thirty-five patients with intrahepatic duct stone who underwent laparoscopic combined choledochoscopic lithotripsy admitted to our hospital from January 2020 to December 2022 were retrospectively included and divided into a modeling set(n=90)and a validation set(n=45)according to a 2∶1 ratio.patients were divided into relapse group and non-recurrence group according to recurrence status within 1-year follow-up.Univariate Logistic regression analysis was performed to analyze the influencing factors of postoperative recurrence of patients.A nomogram was constructed according to the influencing factors,and calibration curve,consistency index,receiver operating characteristic curve(ROC)and decision curve were used for internal and external verification.Results:In the modeling set,patients with bilateral stone distribution,maximum stone diameter≥10 mm,bile duct stenosis,multiple stone numbers,and paracystic diverticulum in the recurrent group had higher serum levels of RBP4 than those in the non-recurrent group at 7 days after surgery,and lower serum levels of CCK-A than those in the non-recurrent group at 7 days after surgery(P<0.05).The factors of recurrence after hepatolithiasis surgery were the maximum stone diameter≥10 mm,bilateral stone distribution,bile duct stenosis,multiple stone numbers,paracystic diverticulum,serum RBP4 level 7 days after surgery,and serum CCK-A level 7 days after surgery(P<0.05).A nomogram was constructed based on the influencing factors,and internal and external validation showed that the prediction model had good predictive ability and clinical net benefit.Conclusion:The influencing factors of recurrence after hepatolithiasis surgery include serum RBP4 levels 7 days after surgery and bilateral stone distribution.The nomogram prediction model constructed based on

关 键 词：肝胆管结石 腹腔镜 胆道镜取石术 术后复发 

分 类 号：R657.42[医药卫生—外科学]