Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510250, PR China.
Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, Chongqing, 400038, PR China.
Clin Res Hepatol Gastroenterol. 2024 Aug;48(7):102413. doi: 10.1016/j.clinre.2024.102413. Epub 2024 Jul 1.
BACKGROUND: Prior typing methods fail to provide predictive insights into surgical complexities for extrahepatic choledochal cyst (ECC). This study aims to establish a new classification system for ECC through clustering of imaging results. Additionally, it seeks to compare the differences among the identified ECC types and assess the levels of surgical difficulty. METHODS: The imaging data of 124 patients were automatically grouped through a K-means clustering analysis. According to the characteristics of the new grouping, corrections and interventions were carried out to establish a new classification. Demographic data, clinical presentations, surgical parameters, complications, reoperation, and prognostic indicators were analyzed according to different types. Factors contributing to prolonged surgical time were also evaluated. RESULTS: A new classification system of ECC: Type A (upper segment), Type B (middle segment), Type C (lower segment), and Type D (entire bile duct). The incidences of comorbidities (calculus or infection) were significantly different (P = 0.000, P = 0.002). Additionally, variations in the incidence of postoperative biliary stricture were statistically significant (P = 0.046). The operative time was significantly different between groups (P = 0.001). Age, BMI > 30, classification, and the presence of combined stones exhibit a significant association with prolonged operative time (P = 0.002, P = 0.000, P = 0.011, P = 0.011). CONCLUSION: In conclusion, our utilization of machine learning-driven cluster analysis has enabled the creation of a novel extrahepatic biliary dilatation typology. This classification, in conjunction with factors like age, combined stone occurrence, and obesity, significantly influences the complexity of laparoscopic choledochal cyst surgery, offering valuable insights for improved surgical treatment.
背景:先前的分型方法未能提供对肝外胆管囊状扩张症(ECC)手术复杂性的预测性见解。本研究旨在通过聚类成像结果建立一种新的 ECC 分类系统。此外,还比较了不同 ECC 类型之间的差异,并评估了手术难度的水平。
方法:通过 K-均值聚类分析自动对 124 例患者的影像学数据进行分组。根据新分组的特点,进行了校正和干预,以建立新的分类。根据不同类型分析了人口统计学数据、临床表现、手术参数、并发症、再次手术和预后指标。还评估了导致手术时间延长的因素。
结果:ECC 的一种新分类系统:A型(上段)、B 型(中段)、C 型(下段)和 D 型(整个胆管)。合并症(结石或感染)的发生率有显著差异(P = 0.000,P = 0.002)。此外,术后胆管狭窄的发生率也存在显著差异(P = 0.046)。各组之间的手术时间有显著差异(P = 0.001)。年龄、BMI > 30、分类和合并结石与手术时间延长显著相关(P = 0.002,P = 0.000,P = 0.011,P = 0.011)。
结论:总之,我们利用机器学习驱动的聚类分析创建了一种新的肝外胆管扩张分类。这种分类,结合年龄、合并结石发生和肥胖等因素,显著影响腹腔镜胆总管囊肿手术的复杂性,为改善手术治疗提供了有价值的见解。
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