Chen Gan, Li Min, Cao Baoqiang, Xu Qingwen, Zhang Zhigong
Department of Vascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Department of Hepatobiliary Pancreatic Surgery, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China.
Wideochir Inne Tech Maloinwazyjne. 2022 Jun;17(2):303-308. doi: 10.5114/wiitm.2022.114539. Epub 2022 Mar 16.
In some cases, laparoscopic cholecystectomy (LC) may be very difficult and easily converted to laparotomy, causing many complications to patients and prolonging the prognosis time. Thus, to evaluate the difficulty of LC before operation is extremely important.
To explore the risk factors of difficult cholecystectomy (DC) and to establish a risk prediction model of DC.
The data of 201patients who underwent cholecystectomy from 1 January 2018 to 10 November 2019 were analysed retrospectively. The highest quartile (P75) of cholecystectomy operation time was used as a cutting point of DC (≥ P75) and NLC (< P75). Logistic regression was used to analyse the influencing factors of DC, and its risk model was constructed for prediction.
Multivariate logistic regression analysis showed that body mass index (BMI) > 25 kg/m, white blood cell (WBC) > 10 × 10/l, calculus incarcerated in neck of gallbladder, frequency of acute cholecystitis in the last 2 months > 4 times, thickness of gallbladder wall > 0.5 cm, and maximum diameter of gallstone > 2 cm were independent risk factors for DC. The prediction efficiency of the logistic regression equation was 0.879 ( = 1.457, p > 0.05).
Based on analysis of risk factors, a logistic risk prediction model for difficult cholecystectomy was established. This model can be used to predict the difficulty of cholecystectomy.
在某些情况下，腹腔镜胆囊切除术（LC）可能非常困难且容易转为开腹手术，给患者带来许多并发症并延长预后时间。因此，术前评估LC的难度极为重要。
探讨困难胆囊切除术（DC）的危险因素并建立DC的风险预测模型。
回顾性分析2018年1月1日至2019年11月10日期间接受胆囊切除术的201例患者的数据。将胆囊切除术手术时间的最高四分位数（P75）用作DC（≥P75）和非困难胆囊切除术（NLC，<P75）的切点。采用逻辑回归分析DC的影响因素，并构建其风险模型进行预测。
多因素逻辑回归分析显示，体重指数（BMI）>25kg/m²、白细胞（WBC）>10×10⁹/L、胆囊颈部结石嵌顿、过去2个月内急性胆囊炎发作次数>4次、胆囊壁厚度>0.5cm以及胆结石最大直径>2cm是DC的独立危险因素。逻辑回归方程的预测效率为0.879（χ²=1.457，p>0.05）。
基于危险因素分析，建立了困难胆囊切除术的逻辑风险预测模型。该模型可用于预测胆囊切除术的难度。
