急性胆囊炎腹腔镜胆囊切除术后并发症危险因素与风险预测模型的构建

Construction of risk factors and risk prediction model of complications after laparoscopic cholecystectomy for acute cholecystitis

目的:探讨急性胆囊炎患者行腹腔镜胆囊切除术(LC)术后并发症风险预测模型的构建及实证研究。方法:回顾性分析2021年1月—2023年1月收治的101例行LC治疗急性胆囊炎患者的临床资料,根据术后并发症发生情况(术后30 d内,出现以下症状,如腹腔出血、胆漏、胆道损伤、伤口感染)分为并发症组(26例)和无并发症组(75例)两组,采用单因素分析、多因素Logistic回归分析急性胆囊炎患者行LC术后并发症的影响因素,并构建风险预测模型,采用受试者工作特征(ROC)曲线分析该模型的预测价值。结果:单因素分析显示,性别、BMI、肝硬化、胆囊结石、胆囊萎缩、CCI分级等与急性胆囊炎LC治疗术后并发症发生无关(P>0.05),而年龄、胆囊壁厚度、三角解剖变异、ASA-PS分级、TG13/TG18分级等与急性胆囊炎LC治疗术后并发症的发生有关(P<0.05)。多因素Logistic回归分析显示,年龄>70岁、胆囊壁厚度≥5 mm、三角解剖变异、ASA-PS分级Ⅲ~Ⅵ级、TG13/TG18分级Ⅲ级等均为急性胆囊炎患者行LC治疗术后并发症的独立危险因素(P<0.05)。ROC曲线显示,基于以上5个指标构建的风险预测模型的AUC为0.836,敏感度、特异度为80.8%、82.7%,均高于模型中各单项指标,且该风险预测模型拟合程度较好(Hosmer-Lemeshowχ2=0.998,P=0.986)。结论:年龄>70岁、胆囊壁厚度≥5 mm、三角解剖变异、ASA-PS分级Ⅲ~Ⅵ级、TG13/TG18分级Ⅲ级等为急性胆囊炎患者行LC治疗术后并发症独立危险因素,基于以上5个指标构建的风险预测模型对此类患者术后并发症具有较高预测价值。

Objective:To investigate the construction and empirical study of the risk prediction model of postoperative complications in patients with acute cholecystitis undergoing laparoscopic cholecystectomy(LC).Method:The clinical data of 101 patients with acute cholecystitis treated by LC from January 2021 to January 2023 were retrospectively analyzed.According to the occurrence of postoperative complications(the following symptoms occurred within 30 days after surgery,such as abdominal hemorrhage,bile leakage,biliary tract injury and wound infection),pa-tients were divided into complication group(26 cases)and non-complication group(75 cases).Uni-variate analysis and multivariate Logistic regression were used to analyze the affecting factors of complications after LC in patients with acute cholecystitis,and the risk prediction model was con-structed,and the predictive value of the model was analyzed by receiver operating characteristic curve(ROC curve).Result:Univariate analysis showed that gender,BMI,cirrhosis,gallstone,gall-bladder atrophy and CCI grade were not correlated with postoperative complications in patients with acute cholecystitis after LC treatment(P>0.05).Age,gallbladder wall thickness,triangular ana-tomic variation,ASA-PS grade,TG13/TG18 grade were associated with postoperative complica-tions of LC in patients with acute cholecystitis(P<0.05).Multivariate Logistic regression analysis showed that age>70 years old,gallbladder wall thickness≥5mm,triangular anatomical variation,ASA-PS gradeⅢ~Ⅵ,TG13/TG18 gradeⅢwere all independent risk factors for postoperative complications(P<0.05).ROC analysis showed that the AUC of the risk prediction model constructed based on the above five indicators was 0.836,and the sensitivity and specificity were 80.8%and 82.7%,which were all higher than the single indicators in the model,and the degree of fit of the risk prediction model was good(Hosmer-Lemeshow x2=0.998,P=0.986).Conclusion:Age>70 years old,gallbladder wall thickness≥5mm,triangular anatomic variation,ASA-PS gradeⅢ~Ⅵand TG13/TG18 gradeⅢwere independent risk factors for postoperative complications in patients with acute cholecystitis undergoing LC treatment.The risk prediction model constructed based on the above five indicators has high predictive value for postoperative complications in patients with acute cholecystitis undergoing LC treatment.