腹腔镜下肝切除术手术难度评分系统的建立与应用

Establishment of surgical difficulty scoring system for laparoscopic liver resection and its application

目的:建立腹腔镜下肝切除术手术难度评分系统,并初步应用。方法:对2014年1月—2017年5月重庆医科大学附属第一医院收治的83例行腹腔镜下肝切除术患者的临床资料进行回顾性分析,根据手术时间及是否中转开腹将患者分成简单组和困难组,对引起手术困难的因素行单因素与多因素Logistic回归分析,根据回归方程的系数建立预测手术难度的评分系统。对83例病例进行评分,通过受试者工作特征曲线(ROC)验证评分系统评价的效能。结果:单因素分析显示年龄、性别、病灶的直径、病灶的性质、病灶距下腔静脉的距离、病灶是否位于左外叶在简单组和困难组间差异有统计学差异(均P<0.05),多因素分析显示病灶直径(OR=7.034,P=0.043),病灶与下腔静脉的距离(OR=12.881,P=0.001),病灶是否位于左外叶(OR=26.774,P=0.001)为手术难度的独立影响因素。根据上述因素建立评分系统,效能检验显示,ROC曲线下面积为0.897(95%CI=0.826~0.968),截断值为4,患者评分≥4为手术困难。结论:手术难度评分系统对预测腹腔镜下肝切除术的难度有较好的指导意义。手术医生可以根据术前难度评分合理的选择手术方式。

Objective： To establish a difficulty scoring system and to make a preliminary application. to predict the difficulty of laparoscopic liver resection （LLR） Methods： The clinical data of 83 patients undergoing LLR between January 2014 and May 2017 in the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The patients were divided into simple group and difficult group according to the operative time and whether converted to open surgery or not. The factors for surgical difficulty were determined by univariate and multivariate Logistic regression analysis. Then, the scoring system for predicting the surgical difficulty was built based on the coefficient of the regression analysis. Tne 83 patients were scored and the validity of the scoring system was verified through receiver operatingcharacteristic curve （ROC）. Results： ＂Ihe univariate analysis showed that there were significant differences in age, sex, lesion size, lesion traits, distance of the lesion from the inferior vena cava and whether the lesion was located in the left lateral lobe between simple group and difficult group （all P〈0.05）; multivariate analysis revealed that lesion size （0R=7.034, P=0.043）, the distance between the lesion and the inferior vena cava （0R=12.881, P=0.001）, and whether the lesion was located in the left lateral lobe （OR=26.774, P=0.001） were independent influential factors for surgical difficulty. qqae scoring system was established based on the above factors. Efficiency estimation showed that the area under the ROC curve was 0.897 （95% CI=0.826-0.968） with a cut-off value of 4, so the score of a patient equal to or larger than 4 was regarded as surgical difficulty. Conclusion： Surgical difficulty scoring system has certain guiding significance for predicting surgical difficulty in LLR. Surgeons can choose the surgical procedure by referring to the preoperative difficulty score.