Zhu Bo, Wang Yingxin, Zhang Zhenduo, Wang Liwei, Ma Yashuai, Li Ming
Department of General Surgery, Shijiazhuang People's Hospital, Shijiazhuang, China.
Front Med (Lausanne). 2025 Apr 22;12:1561769. doi: 10.3389/fmed.2025.1561769. eCollection 2025.
Preoperative prediction of difficult laparoscopic cholecystectomy (DLC) remains challenging, as intraoperative anatomical complexity significantly increases complication risks. Current studies have not reached consensus on definitive risk factors for DLC.
This retrospective study aimed to identify DLC risk factors and develop a predictive model. We analyzed clinical data from 265 patients undergoing laparoscopic cholecystectomy (LC) at the Department of General Surgery, Shijiazhuang People's Hospital, between September 2022 and June 2024. Risk factors were explored through least absolute shrinkage and selection operator (LASSO) regression, multivariate analysis, and receiver operating characteristic (ROC) curves, with a nomogram constructed for prediction.
Among 265 eligible patients, four independent risk factors were identified: thickness of gallbladder wall ( = 0.0007), cystic duct length ( < 0.0001), cystic duct diameter ( < 0.0001), and gallbladder neck stones ( = 0.0002). The nomogram demonstrated strong predictive performance, with an area under the curve (AUC) of 0.915 in the training cohort and 0.842 in the validation cohort. Calibration curves indicated excellent model fit.
The proposed predictive model integrating gallbladder neck stones, thickness of gallbladder wall, cystic duct length, and cystic duct diameter may assist surgeons in preoperative DLC risk stratification. Further validation through multicenter prospective studies is warranted.
术前预测困难的腹腔镜胆囊切除术（DLC）仍然具有挑战性，因为术中解剖复杂性会显著增加并发症风险。目前的研究尚未就DLC的确切危险因素达成共识。
这项回顾性研究旨在确定DLC的危险因素并建立预测模型。我们分析了2022年9月至2024年6月期间在石家庄市人民医院普通外科接受腹腔镜胆囊切除术（LC）的265例患者的临床资料。通过最小绝对收缩和选择算子（LASSO）回归、多变量分析和受试者工作特征（ROC）曲线探索危险因素，并构建列线图进行预测。
在265例符合条件的患者中，确定了四个独立危险因素：胆囊壁厚度（=0.0007）、胆囊管长度（<0.0001）、胆囊管直径（<0.0001）和胆囊颈部结石（=0.0002）。列线图显示出强大的预测性能，训练队列中的曲线下面积（AUC）为0.915，验证队列中的AUC为0.842。校准曲线表明模型拟合良好。
所提出的整合胆囊颈部结石、胆囊壁厚度、胆囊管长度和胆囊管直径的预测模型可能有助于外科医生在术前对DLC进行风险分层。有必要通过多中心前瞻性研究进行进一步验证。
