结石性胆囊炎腹腔镜术后并发症发生情况及血清GGT/ALP比值的预测效能

The incidence of postoperative complications of laparoscopic calculous cholecystitis and the predictive efficacy of serum GGT/ALP ratio

目的 探讨结石性胆囊炎腹腔镜术后并发症发生情况及血清γ-谷氨酰转肽酶/碱性磷酸酶(GGT/ALP)比值的预测效能。方法 选取2021年11月至2023年10月于山东大学齐鲁医院德州医院接受腹腔镜胆囊切除术治疗的124例结石性胆囊炎患者。采用多因素Logistic逐步回归分析结石性胆囊炎患者腹腔镜术后发生并发症的影响因素;比较两组血清GGT、ALP水平及GGT/ALP比值;采用受试者工作特性(ROC)曲线评估GGT、ALP、GGT/ALP比值对结石性胆囊炎患者腹腔镜术后发生并发症的预测价值。结果 124例结石性胆囊炎患者腹腔镜术后并发症发生率为9.68%(12/124)。并发症组年龄≥60岁、有腹部手术史、胆囊壁厚度≥5 mm、胆囊三角区粘连、胆囊三角区变异、手术时机为发病≥48 h、术前WBC水平≥15×10^(9)的占比均高于无并发症组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,胆囊壁厚度≥5 mm、胆囊三角区粘连、胆囊三角区变异、术前WBC水平≥15×10^(9)是结石性胆囊炎患者腹腔镜术后发生并发症的独立危险因素(P<0.05)。并发症组血清GGT、ALP水平及GGT/ALP比值均高于无并发症组,差异有统计学意义(P<0.05)。GGT、ALP预测结石性胆囊炎患者腹腔镜术后发生并发症的曲线下面积(AUC)分别为0.852、0.747,低于GGT/ALP比值预测(0.901)。结论 GGT/ALP比值对结石性胆囊炎患者腹腔镜术后发生并发症具有一定的预测价值,可作为潜在的预测标记物。

Objective To investigate the incidence of postoperative complications of laparoscopic calculous cholecystitis and the predictive efficacy of serum amma⁃glutamyltranspeptidase/alkaline phosphatase(GGT/ALP)ratio.Methods A total of 124 cases of calculous cholecystitis who received laparoscopic chole⁃cystectomy at Shandong University Qilu Hospital Dezhou Hospital from November 2021 to October 2023 were retrospectively selected.They were divided into two groups:a complication group(n=12)and a non⁃complica⁃tion group(n=112)based on whether complications occurred within 28 days after surgery.The influencing fac⁃tors of postoperative complications for laparoscopic calculous cholecystitis were explored using multivariate lo⁃gistic stepwise regression analysis.Serum levels of GGT and ALP,and GGT/ALP ratio,were compared be⁃tween the two groups.The predictive value of GGT,ALP,and the GGT/ALP ratio for postoperative complica⁃tions in patients with laparoscopic calculous cholecystitis was evaluated using ROC analysis.Results The com⁃plication rate of 124 patients with laparoscopic cholecystitis was 9.68%(12/124).The proportion of patients aged≥60 years,with a history of abdominal surgery,gallbladder wall thickness≥5 mm,gallbladder triangle ad⁃hesion,gallbladder triangle variation,operation time≥48 h,and preoperative WBC level≥15×10^(9) in the com⁃plication group was higher than that in the non⁃complication group,with statistical significance(P<0.05).Gall⁃bladder wall thickness≥5 mm,gallbladder triangle adhesion,gallbladder triangle variation and preoperative WBC level≥15×10^(9) were identified as independent risk factors for postoperative complications in cases of lapa⁃roscopic cholecystitis(P<0.05).The levels of serum GGT,ALP,and GGT/ALP ratio in the complication group were higher than those in the non⁃complication group,with statistical significance(P<0.05).The area un⁃der the curve(AUC)predicted by GGT and ALP for postoperative complications in patients with laparoscopic calculous cholecystitis were 0.852 and 0.747,respectively,which were lower than that predicted by the GGT/ALP ratio(0.901).Conclusion The GGT/ALP ratio has a certain predictive value for postoperative complica⁃tions in cases of laparoscopic calculous cholecystitis and can be used as a potential predictive marker.