Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery

Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving surgery.This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence.Methods:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected.The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables.The C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence.Results:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five variables.The results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone recurrence.Moreover,the calibration curve showed good consistency between the predicted probability and actual probability.Conclusions:The nomogram model for the prediction of gallstone recurrence might help clinicians develop a proper treatment strategy for patients with gallstones.Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.

Snare-assisted flexible endoscope in trans-gastric endoscopic gallbladder-preserving surgery:A pilot animal study

BACKGROUND Natural orifice transluminal endoscopic surgery(NOTES)gallbladder-preserving surgery by flexible endoscopy is an emerging technology.However,the gallbladder fails to obtain traction and positioning functions during the operation.AIM To evaluate the feasibility and safety of a new surgical method,“snare-assisted pure NOTES gallbladder-preserving surgery”.METHODS Eight miniature pigs were randomly divided into the experimental group[NOTES gallbladder-preserving surgery using the snare device,snare assisted(SA)]and the control group(NOTES gallbladder-preserving surgery without using the snare device,NC),with four cases in each group.The differences between the two groups of animals in operating time,operating workload,complications,adverse events,white blood cells,and liver function were determined.RESULTS No differences were found in the surgical success rate,gallbladder incision closure,white blood cell count,or liver function between the two groups.The total operating time,gallbladder incision blood loss,gallbladder disorientation time,gallbladder incision closure time,and workload scores on the National Aeronautics and Space Administration-Task Load Index were significantly reduced in the SA group(P<0.05).CONCLUSION These results indicated that snare-assisted pure NOTES gallbladder-preservation surgery using standard endoscopic instruments reduced the difficulty of operation,shortened operation time,and did not increase complications in pigs.A new method for pure NOTES gallbladder-preservation surgery was provided.

内镜微创保胆取石术后结石复发危险因素和手术指征评分表的应用

目的探讨内镜微创保胆取石术后结石复发的危险因素;评价保胆取石手术指征评分表的实用价值和应用前景。方法分析2010年8月-2014年8月46例胆囊结石患者行内镜微创保胆取石术的临床资料,根据内镜微创保胆取石手术指征评分将患者分为三组,A组22例,B组13例,C组11例;观察各组患者手术前、后胆囊收缩率和胆囊壁厚度的变化,分析结石复发的危险因素。结果 46例手术均获成功,3例术后复发,单因素分析结果显示家族史、血清甘油三酯、血清胆固醇、胆囊壁厚度与内镜微创保胆取石术术后结石复发有关(P<0.05)。重复测量方差分析结果显示:胆囊壁厚度在不同时间点上差别有统计学意义(F=19.866,P=0.000),胆囊壁厚度随观察时间点变化逐渐变小。胆囊收缩率在组间、各时间点及分组方面与时间的交互作用均有统计学意义,且A组明显高于B、C组(P<0.05),与手术前相比,手术后三组患者胆囊收缩率均呈上升趋势。结论内镜微创保胆取石术术后结石复发与家族史、高血脂、胆囊功能降低有关。内镜微创保胆取石手术指征评分表对术前病例的筛选具有良好的可行性和实用性。