腹腔镜胆囊切除术后胆总管结石复发的列线图预测模型构建与评估

Development and evaluation of a nomogram prediction model for the recurrence of choledocholithiasis after laparoscopic cholecystectomy

目的:构建腹腔镜胆囊切除术(LC)后胆总管结石复发的列线图模型,并评估模型的区分度及一致性。方法:回顾分析2016年1月至2020年12月行LC的470例胆囊结石患者的临床资料。将随访中胆总管结石复发的患者纳入复发组(n=60),未复发的患者纳入非复发组(n=410)。采用多因素Logistic回归分析筛选LC术后胆总管结石复发的危险因素;采用R软件构建预测LC术后胆总管结石复发的列线图模型,并采用受试者工作特征曲线及校准曲线评估列线图模型的区分度与一致性。结果:复发组年龄≥60岁、胆道感染、胆总管扩张、胆道口括约肌切开、壶腹周边憩室、胆总管直径≥15 mm的比例高于非复发组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,胆道感染、胆总管扩张、壶腹周边憩室、胆总管直径≥15 mm是LC术后胆总管结石复发的危险因素(P<0.05)。列线图模型预测评估的区分度受试者工作特征曲线下面积为0.802,区分度较好,列线图模型的校准曲线预测值与实际值基本一致,Hosmer-Lemeshow拟合优度检验χ^(2)=8.662,P=0.372,一致性较好。结论:胆道感染、胆总管扩张、壶腹周边憩室、胆总管直径≥15 mm是影响LC术后胆总管结石复发的危险因素,根据上述危险因素建立的列线图有助于预测LC术后胆总管结石的复发风险。

Objective:To establish a nomogram prediction model of the choledocholithiasis recurrence after laparoscopic cholecystectomy(LC),and to evaluate the differentiation and consistency of the model.Methods:The clinical data of 470 patients with cholecystolithiasis who underwent LC from Jan.2016 to Dec.2020 were retrospectively analyzed.According to the follow-up results,patients who suffered from recurrence of choledocholithiasis were classified as the recurrence group(n=60),whereas those who did not have a recurrence of choledocholithiasis were classified as the non-recurrence group(n=410).Multivariate logistic regression analysis was used to screen the risk factors of the recurrence of choledocholithiasis after LC.R software was used to develop a nomogram model to predict the recurrence of choledocholithiasis after LC.The receiver operating characteristic curve and calibration curve were used to evaluate the differentiation and consistency of the nomogram model.Results:The proportion of age≥60 years old,biliary tract infection,the dilation of common bile duct,the incision of biliary sphincter,periampullary diverticula,and common bile duct diameter≥15 mm in the recurrence group were higher than those in the non-recurrence group(P<0.05).Multivariate logistic regression analysis showed that biliary tract infection,common bile duct dilation,periampullary diverticula,and common bile duct diameter≥15 mm were risk factors for the recurrence of choledocholithiasis after LC(P<0.05).The area under the receiver operating characteristic curve of the predicting and evaluating discriminative degree in nomogram model was 0.802,which indicated a good degree of discrimination,the predicted value of the calibration curve for nomogram model was basically consistent with the actual value,and the Hosmer-Lemeshow goodness-of-fit test showedχ^(2)=8.662,P=0.372,which indicated a good consistency.Conclusions:Biliary tract infection,common bile duct dilation,periampullary diverticula and common bile duct diameter≥15 mm are risk factors for the recurrence of choledocholithiasis after LC,and the nomogram based on these independent risk factors may help to predict the risk of choledocholithiasis recurrence after LC.