[1]葛子豪,姚 康,童朝刚.困难腹腔镜胆囊切除术术前评估及风险预测模型构建[J].医学信息,2023,36(07):41-46.[doi:10.3969/j.issn.1006-1959.2023.07.008]
　GE Zi-hao,YAO Kang,TONG Chao-gang.Preoperative Evaluation and Risk Prediction Model Construction of Difficult Laparoscopic Cholecystectomy[J].Journal of Medical Information,2023,36(07):41-46.[doi:10.3969/j.issn.1006-1959.2023.07.008]
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困难腹腔镜胆囊切除术术前评估及风险预测模型构建()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年07期
页码:
41-46
栏目:
临床信息学
出版日期:
2023-04-01

文章信息/Info

Title:
Preoperative Evaluation and Risk Prediction Model Construction of Difficult Laparoscopic Cholecystectomy
文章编号:
1006-1959（2023）07-0041-06
作者:
葛子豪; 姚 康; 童朝刚
（安徽医科大学附属巢湖医院肝胆外科，安徽 巢湖 238000）
Author(s):
GE Zi-hao; YAO Kang; TONG Chao-gang
(Department of Hepatobiliary Surgery,Chaohu Hospital of Anhui Medical University,Chaohu 238000,Anhui,China)
关键词:
腹腔镜胆囊切除术; 模型预测; 危险因素; 列线图
Keywords:
Laparoscopic cholecystectomy; Model prediction; Risk factor; Nomogram
分类号:
R657.4
DOI:
10.3969/j.issn.1006-1959.2023.07.008
文献标志码:
A
摘要:
目的 建立困难腹腔镜胆囊切除术（DLC）术前评估模型，预测手术难度，减少手术相关并发症，提高手术安全性。方法 回顾分析我院2019年1月-2021年12月行LC手术患者521例的临床资料，根据标准手术时长的75%时间分为困难组（DLC组）和非困难组（NDLC组）。对两组资料进行单因素分析，筛选单因素分析有统计学意义的指标纳入多因素Logistic回归分析，用Logistic分析有统计学意义的指标构建DLC术前风险评估模型，并构建受试者工作特征曲线（ROC）评估模型的效能。基于该模型，使用R语言软件建立DLC风险预测列线图，并绘制校正曲线。结果 521例患者中，DLC组156例；NDLC组365例。单因素分析显示，两组性别、胆囊颈结石嵌顿、胆囊结石直径、胆囊壁厚、既往急性胆囊炎发作史、白细胞、中性粒细胞水平比较，差异有统计学意义（P＜0.05）；多因素Logistic回归显示，男性、胆囊颈结石嵌顿、胆囊结石直径≥2.5 cm、胆囊壁厚≥4 mm、既往急性胆囊炎发作史、中性粒细胞≥7×109/L是DLC的独立危险因素（P＜0.05）；ROC曲线下面积为0.776。基于该多因素回归分析构建的列线图校正曲线显示一致性较好。结论 DLC术前评估模型可以较好预测手术难度，根据手术难度不同，采取相应的临床策略，有助于实现精准化医疗，提高临床效率。
Abstract:
Objective To establish a preoperative evaluation model for difficult laparoscopic cholecystectomy (DLC), predict the difficulty of surgery, reduce surgery-related complications, and improve surgical safety.Methods The clinical data of 521 patients who underwent LC in our hospital from January 2019 to December 2021 were retrospectively analyzed. According to 75% of the standard operation time, they were divided into difficult group (DLC group) and non-difficult group (NDLC group). Univariate analysis was performed on the two groups of data, and the indicators with statistical significance in univariate analysis were included in multivariate Logistic regression analysis. The preoperative risk assessment model of DLC was constructed by using the indicators with statistical significance in Logistic analysis, and the receiver operating characteristic curve (ROC) was constructed to evaluate the efficacy of the model. Based on this model, the DLC risk prediction nomogram was established by using R language software, and the correction curve was drawn.Results Among the 521 patients, there were 156 patients in the DLC group and 365 patients in the NDLC group. Univariate analysis showed that there were significant differences in gender, gallbladder neck stone incarceration, gallbladder stone diameter, gallbladder wall thickness, previous history of acute cholecystitis, white blood cell and neutrophil levels between the two groups (P<0.05). Multivariate Logistic regression showed that male, gallbladder neck stone incarceration, gallbladder stone diameter ≥2.5 cm, gallbladder wall thickness ≥4 mm, previous history of acute cholecystitis, neutrophil ≥7×109/L were independent risk factors for DLC (P<0.05). The area under the ROC curve was 0.776. The correction curve of the nomogram constructed based on the multivariate regression analysis showed good consistency.Conclusion DLC preoperative evaluation model can better predict the difficulty of surgery. According to the difficulty of surgery, corresponding clinical strategies can be adopted to help achieve precision medicine and improve clinical efficiency.

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更新日期/Last Update: 1900-01-01