摘要
目的探讨腹腔镜胆总管探查术(LCBDE)患者的术中碎石需求,并分析相关早期预测因素,以构建LCBDE术中碎石需求预测模型。方法纳入2022年3月—2024年3月浙江省人民医院淳安分院收治的152例LCBDE患者,根据术中腹腔镜下碎石辅助与否分为需求组(33例)和非需求组(119例)。比较2组患者一般资料、临床资料,采用多因素logistic回归分析研究LCBDE患者术中碎石需求的影响因素。结果需求组年龄、胆总管结石直径<1.1 cm占比均低于非需求组,发热、黄疸、恶心呕吐及胰腺周围渗出占比均高于非需求组(P<0.05)。多因素logistic回归分析显示,年龄(OR=0.824)、发热(OR=10.112)、黄疸(OR=8.071)、恶心呕吐(OR=5.823)、胆总管结石直径(OR=9.148)均为LCBDE患者术中碎石需求的独立影响因素(P<0.05)。基于五项指标构建的联合预测模型预测LCBDE患者术中碎石需求的AUC为0.914(95%CI:0.858~0.953),模型预测LCBDE患者术中碎石需求的发生风险与实际风险一致性良好。结论LCBDE用于胆总管结石治疗时,仍有部分患者术中需要碎石辅助;年龄、发热、黄疸、恶心呕吐和胆总管结石直径是术中碎石需求的独立影响因素,基于五项指标构建的联合预测模型可作为预测LCBDE患者术中碎石需求的临床工具。
Objective To explore the lithotripsy demand of patients undergoing laparoscopic common bile duct exploration(LCBDE),and analyze the related early prediction factors,so as to build a prediction model of the lithotripsy demand during LCBDE.Methods One hundred and fifty-two patients with percutaneous LCBDE admitted to Chun'an Branch of Zhejiang Provincial People's Hospital from March 2022 to March 2024 were divided into demand group(n=33)and non-demand group(n=119)according to the assistance of laparoscopic lithotripsy during operation.The general data and clinical data of patients in the two groups were compared,and the influencing factors of lithotripsy demand in patients with percutaneous LCBDE were analyzed by multivariate logistic regression.Results The ratio of age/common bile duct stone diameter<1.1 cm in demand group was lower than that in non-demand group,and the ratio of fever,jaundice,nausea and vomiting and peripancreatic exudation was higher than that in non-demand group(P<0.05).Multivariate logistic regression analysis showed that age(OR=0.824),fever(OR=10.112),jaundice(OR=8.071),nausea and vomiting(OR=5.823)and common bile duct stone diameter(OR=9.148)were the independent risk factors of lithotripsy demand in patients undergoing percutaneous LCBDE(P<0.05).The ROC curve showed that the AUC of the combined model based on these five indicators was 0.914(95%CI:0.858-0.953),and the combined models predicted the risk of lithotripsy demand in patients with percutaneous LCBDE in good agreement with the actual risk.Conclusion There are still some patients who need lithotripsy during the treatment of choledocholithiasis by percutaneous LCBDE.Age,fever,jaundice,nausea and vomiting and the diameter of common bile duct stones are independent risk factors,and the combined prediction model based on these five indicators can be used as a clinical tool to predict the demand for lithotripsy in patients with percutaneous LCBDE.
作者
胡淑珍
冯霞
张乐逸
HU Shuzhen;FENG Xia;ZHANG Leyi(Department of Hepatobiliary Surgery,Chun'an First People's Hospital(Chun'an Branch of Zhejiang Provincial People's Hospital),Hangzhou,Zhejiang 311700,China;不详)
出处
《中华全科医学》
2025年第12期2059-2063,共5页
Chinese Journal of General Practice
基金
浙江省医药卫生科技计划项目(2022ZH008)。
关键词
腹腔镜
胆总管
探查术
碎石
影响因素
校准曲线
Laparoscopy
Common bile duct
Exploration
Gravel
Influencing factors
Calibration curve
