困难腹腔镜胆囊切除术风险预测模型的构建与临床应用

Construction and clinical application of a risk prediction model for difficult laparo-scopic cholecystectomy

目的目的探讨困难腹腔镜胆囊切除术的独立风险因素,构建风险预测模型。方法方法回顾性分析2022年2月~2023年8月于空军军医大学附属西京医院肝胆外科住院期间行LC患者244例,将其分为NDLC组(n=181)和DLC组(n=63)。通过单因素和Logistic回归分析DLC的风险因素,并建立风险预测模型。结果结果性别、中性粒细胞、胆囊壁厚度、腹部手术史是DLC的危险因素,构建DLC风险预测模型,模型的ROC曲线下面积为0.722,敏感度为63.5%,特异度为77.9%。采用R软件绘制列线图并评价。结论结论通过Logistic回归分析,性别、中性粒细胞、胆囊壁厚度及腹部手术史均是DLC的独立风险因素,据此构建的风险预测模型具有良好的准确度、区分度和预测效果。

Objective To investigate the independent risk factors of difficult laparoscopic cholecystectomy(DLC)and to con-struct a risk prediction model.Methods A retrospective analysis was conducted on 244 patients who underwent laparoscopic chole-cystectomy(LC)in the Department of Hepatobiliary Surgery at Xijing Hospital,Air Force Medical University,from February 2022 to August 2023.Patients were divided into the non-difficult laparoscopic cholecystectomy(NDLC)group(n=181)and the DLC group(n=63).The risk factors for DLC were analyzed using univariate and logistic regression analysis,and a risk prediction model was established.Results Gender,neutrophil count,gallbladder wall thickness,and a history of abdominal surgery were identified as independent risk factors for DLC.The area under the receiver operating characteristic(ROC)curve for the model was 0.722,with a sensitivity of 63.5%and a specificity of 77.9%.A nomogram was created and evaluated using R software.Conclusion Logistic re-gression analysis confirmed that gender,neutrophil count,gallbladder wall thickness,and a history of abdominal surgery are indepen-dent risk factors for DLC.The risk prediction model constructed has good accuracy,discrimination,and predictive effectiveness.