Wei Hai-Hong, Wang Yu-Xiang, Xu Bin, Zhang Yong-Gui
Department of Cardiovascular Surgery, Shanghai Tongren Hospital, Shanghai, China.
Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Heliyon. 2024 Aug 10;10(16):e36081. doi: 10.1016/j.heliyon.2024.e36081. eCollection 2024 Aug 30.
Laparoscopic cholecystectomy (LC) is required for acute cholecystitis patient with percutaneous transhepatic gallbladder drainage (PTGBD). However, it's unknown how to distinguishing the surgical difficulty for these patients.
Data of patients who underwent LC after PTGBD between 2016 and 2022 were collected. Patients were categorized into difficult and non-difficult operations based on operative time, blood loss, and surgical conversion. Performance of prediction model was evaluated by ROC, calibration, and decision curves.
A total of 127 patients were analyzed, including 91 in non-difficult operation group and 36 in difficult operation group. Elevated CRP ( = 0.011), pericholecystic effusion ( < 0.001), and contact with stomach or duodenal ( = 0.015) were independent risk factors for difficult LC after PTGBD. A nomogram was developed according to these risk factors, and was well-calibrated and good at distinguishing difficult LC after PTGBD.
Preoperative elevated systemic and local inflammation indictors are predictors for difficult LC after PTGBD.
对于行经皮经肝胆道胆囊引流术（PTGBD）的急性胆囊炎患者，需要进行腹腔镜胆囊切除术（LC）。然而，如何区分这些患者的手术难度尚不清楚。
收集2016年至2022年间接受PTGBD后行LC的患者数据。根据手术时间、失血量和手术中转情况将患者分为困难手术组和非困难手术组。通过ROC曲线、校准和决策曲线评估预测模型的性能。
共分析了127例患者，其中非困难手术组91例，困难手术组36例。CRP升高（P = 0.011）、胆囊周围积液（P < 0.001）以及与胃或十二指肠粘连（P = 0.015）是PTGBD后LC困难的独立危险因素。根据这些危险因素制定了列线图，该列线图校准良好，能够很好地区分PTGBD后LC困难情况。
术前全身和局部炎症指标升高是PTGBD后LC困难的预测因素。
