肝门部胆管癌患者术后胆漏的危险因素及风险预测模型构建  

Risk Factors and Risk Prediction Model Construction of Postoperative Bile Leakage in Patients with Hilar Cholangiocarcinoma

作　　者：朱丙帅 段希斌[1] 梁占强 ZHU Bingshuai;DUAN Xibin;LIANG Zhanqiang(Zhengzhou Central Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市中心医院,河南郑州450000

出　　处：《河南医学研究》2025年第7期1224-1228,共5页Henan Medical Research

摘　　要：目的探讨肝门部胆管癌(HCCA)患者术后胆漏发生的危险因素并风险预测模型。方法采用病例对照研究方法,收集2021年5月至2022年5月胆管癌根治术后发生胆漏的32例HCCA患者临床病历资料为发生组,另以1∶2比例收集同期术后未发生胆漏的64例HCCA患者病历资料为未发生组。比较两组基线资料、临床资料及术前实验室指标,采用logistic回归分析影响因素,并依据logistic回归分析结果构建风险预测模型,绘制受试者工作特征(ROC)曲线评估预测效能。结果发生组年龄、术前胆管炎占比、3支及以上残余肝断面胆管开口数占比均高于未发生组,术前ALB水平低于未发生组(P<0.05);logistic回归分析显示,年龄、术前胆管炎、术前ALB水平、残余肝断面胆管开口数3支及以上是HCCA患者术后胆漏发生的影响因素(P<0.05);绘制列线图构建HCCA患者术后胆漏发生的风险预测模型,验证模型区分度显示C-index值=0.929,具有良好的区分度;绘制标准曲线显示,校准曲线和Y-X直线相近,模型准确度良好;对模型预测效能进行验证,结果显示风险预测模型评估HCCA患者术后胆漏发生的曲线下面积(AUC)值为0.929,具有一定预测效能。结论年龄、术前胆管炎、术前营养水平低、残余肝断面胆管开口数是HCCA患者术后胆漏发生的影响因素,基于上述指标所得的预测模型预测效能较好。Objective To explore the risk factors and risk prediction model of bile leakage in patients with hilar cholangiocarcinoma(HCCA)after surgery.Methods A case-control study was used to collect the clinical medical records of 32 HCCA patients with bile leakage after radical resection of cholangiocarcinoma from May 2021 to May 22 as the occurrence group,and the medical records of 64 HCCA patients without bile leakage during the same period were collected at a ratio of 1∶2 as the non occurrence group.The baseline data,clinical data and preoperative laboratory indexes were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors.The risk prediction model was constructed according to the results of logistic regression analysis,and the receiver operating characteristic(ROC)curve was drawn to evaluate the prediction efficiency.Results The age,proportion of preoperative cholangitis,and proportion of residual bile duct openings of 3 or more liver sections in the occurrence group were higher than those in the non occurrence group,and preoperative ALB levels were lower than those in the non occurrence group(P<0.05).Logistic regression analysis showed that age,preoperative cholangitis,preoperative ALB level,and the number of residual hepatic bile duct openings of 3 or more were the influencing factors for postoperative bile leakage in HCCA patients(P<0.05).A nomogram was drawn to construct a risk prediction model for postoperative bile leakage in HCCA patients.The discrimination of the model showed that the C-index value was 0.929,which had a good discrimination.The standard curve showed that the calibration curve was similar to the Y-X straight line,and the accuracy of the model was good.The validation of the model’s predictive performance showed that the area under the curve(AUC)value of the risk prediction model for evaluating postoperative bile leakage in HCCA patients was 0.929,indicating a certain predictive performance.Conclusion Age,preoperative cholangitis,low preoper

关 键 词：肝门部胆管癌 胆漏 风险预测模型 影响因素 

分 类 号：R735.8[医药卫生—肿瘤]