| 汪昱,徐建明,莫玲斐.急性结石性胆囊炎行腹腔镜胆囊切除术后并发症的危险因素分析及风险预测模型的建立[J].安徽医药,2022,26(10):2068-2071. |
| 急性结石性胆囊炎行腹腔镜胆囊切除术后并发症的危险因素分析及风险预测模型的建立 |
| Risk factors analysis and risk prediction model establishment of complications after laparoscopic cholecystectomy for acute calculous cholecystitis |
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| DOI：10.3969/j.issn.1009-6469.2022.10.037 |
| 中文关键词: 胆结石 胆囊炎，急性 腹腔镜胆囊切除术 危险因素 风险预测模型 |
| 英文关键词: Cholelithiasis Cholecystitis,acute Laparoscopic cholecystectomy Risk factors Risk prediction model |
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| 中文摘要: |
| 目的分析急性结石性胆囊炎病人行腹腔镜胆囊切除术后发生并发症的危险因素，并建立风险预测模型。方法分析崇州市人民医院肝胆外科 2018年 1月至 2020年 1月 220例行腹腔镜胆囊切除急性结石性胆囊炎病人，单因素和多因素分析急性结石性胆囊炎病人行腹腔镜胆囊切除术后发生并发症的危险因素，并建立风险预测模型。结果并发症组医师熟练程度 ≥200例的为 60.87%(14/23)；非并发症组医师熟练程度 ≥200例的为 31.98%(63/197)，并发症组合并急性炎症的为 65.22%(15/ 23)；非并发症组合并急性炎症的为 35.03%(69/197)并发症组胆囊壁厚度 >5 cm的为 65.22%(15/23)；非并发症组胆囊壁厚度 >5 cm的为 30.96%(61/197)，并发症组胆囊三角变异的，为 43.48%(10/23)；非并发症组胆囊三角变异的为 18.78%(37/197)，并发症组腹部手术史的为 43.48%(10/23)；非并发症组腹部手术史的为 21.83%(43/197)，医师熟练程度、合并急性炎症、胆囊壁厚度>5 mm、胆囊三角变异、腹部手术史是急性结石性胆囊炎病人行腹腔镜胆囊切除术后发生并发症的独立危险因素，基于此五项危险因素建立风险预测模型，并验证该列线图模型，实际值和预测值大小基本相近， C-index指数为 0.89［95%CI:(0.87， |
| 英文摘要: |
| Objective To analyze the risk factors for complications after laparoscopic cholecystectomy in patients with acute calcu.lous cholecystitis and to establish a risk prediction model.Methods Analysis was made of 220 patients with acute calculous cholecys.titis who underwent laparoscopic cholecystectomy from January 2018 to January 2020 in the Department of Hepatobiliary Surgery ofChongzhou People's Hospital. Univariate and multivariate analysis of risk factors for complications after laparoscopic cholecystectomyin patients with acute calculous cholecystitis were performed and a risk prediction model was built.Results In the complication group, 60.87% (14/23) of the doctors were proficient in more than or equal to 200 cases; In the non-complication group, 31.98% (63/197) wereproficient in more than or equal to 200 cases. In the complication group 65.22% (15/23) had a complication of acute inflammation,while in the non-complication group 35.03% (69/197) had a complication of acute inflammation. In the complication group 65.22% (15/23) had a gallbladder wall thickness more than 5 cm, while in the non-complication group 30.96% (61/197) had a gallbladder wallthickness more than 5 cm. gallbladder triangle variation was found in 43.48% (10/23) of the complication group and 18.78% (37/197) ofthe non-complication group. In the complication group, 43.48% (10/23) had abdominal surgery history; In the non-complication group,21.83% (43/197) had a history of abdominal surgery. The doctor's proficiency, complicated acute inflammation, gallbladder wall thick.ness more than 5 cm, gallbladder triangle variation, and abdominal surgery history were independent risk factors for complications afterlaparoscopic cholecystectomy in patients with acute calculous cholecystitis. A risk prediction model was established based on these fiverisk factors, and the nomogram model was verified. The actual value and the predicted value were basically similar, the C-index was 0.89[95%CI:(0.87,0.92)], indicating that the discrimination and accuracy of the risk prediction model were good.Conclusion The doc. tor's proficiency, complicated acute inflammation, gallbladder wall thickness more than 5 cm, gallbladder triangle variation and abdom.inal operation history are independent risk factors for complications after laparoscopic cholecystectomy in patients with acute calculouscholecystitis. The established risk prediction nomogram model has high accuracy and discrimination, which has certain clinical guiding |
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