Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China.
Langenbecks Arch Surg. 2023 Sep 13;408(1):357. doi: 10.1007/s00423-023-03099-6.
To explore the surgical risk factors of laparoscopic left-sided hepatectomy for hepatolithiasis and establish and validate a nomogram to estimate the corresponding surgical risks.
Patients with hepatolithiasis who underwent laparoscopic left-sided hepatectomy were retrospectively enrolled. Demographic data, clinicopathological parameters, and surgical factors were collected. Three hundred fifty-three patients were enrolled and randomly divided into training set (n=267) and validation set (n=86) by 3:1. Conversion to laparotomy was used as a surrogate index to evaluate the surgical risk. Univariate analysis was used to screen potential surgical risk factors, and multivariate analysis using logistic regression model was used to screen independent surgical risk factors. Nomogram predicting the surgical risks was established based on the independent risk factors. Discrimination, calibration, decision curve, and clinical impact analyses were used to evaluate the performance of the nomogram on the statistical and clinical aspects both in the training and validation sets.
Five independent surgical risk factors were identified in the training set, including recurrent abdominal pain, bile duct stricture, ASA classification ≥2, extent of liver resection, and biliary tract T tube drainage. No collinearity was found among these five factors, and a nomogram was established. Performance analyses of the nomogram showed good discrimination (AUC=0.850 and 0.817) and calibration (Hosmer-Lemeshow test, p=0.530 and 0.930) capabilities both in the training and validation sets. Decision curve and clinical impact analyses also showed that the prediction performance was clinically valuable.
A nomogram was established and validated to be effective in evaluating and predicting the surgical risk of patients undergoing laparoscopic left-sided hepatectomies for hepatolithiasis.
探讨腹腔镜左半肝切除术治疗肝内胆管结石的手术风险因素，并建立和验证一个列线图来评估相应的手术风险。
回顾性纳入接受腹腔镜左半肝切除术治疗的肝内胆管结石患者。收集患者的人口统计学数据、临床病理参数和手术因素。将 353 例患者按 3:1 的比例随机分为训练集（n=267）和验证集（n=86）。中转开腹作为评估手术风险的替代指标。采用单因素分析筛选潜在的手术风险因素，采用多因素逻辑回归模型筛选独立的手术风险因素。基于独立风险因素建立预测手术风险的列线图。在训练集和验证集中，分别从统计学和临床角度，采用判别、校准、决策曲线和临床影响分析来评估列线图的性能。
在训练集中，共筛选出 5 个独立的手术风险因素，包括复发性腹痛、胆管狭窄、ASA 分级≥2 级、肝切除范围和胆道 T 管引流。这 5 个因素之间无共线性，建立了一个列线图。列线图的性能分析显示，在训练集和验证集中均具有良好的判别能力（AUC=0.850 和 0.817）和校准能力（Hosmer-Lemeshow 检验，p=0.530 和 0.930）。决策曲线和临床影响分析也表明，该预测性能具有临床价值。
建立并验证了一个列线图，可有效评估和预测腹腔镜左半肝切除术治疗肝内胆管结石患者的手术风险。
