关键词: 肝胆管结石手术, 术后复发, 风险模型, 验证研究

Abstract: Objective Construct a risk model for postoperative recurrence of hepatolithiasis and validate it.Methods From January 2020 to December 2021,237 patients undergoing hepatobiliary duct stone surgery were selected.All patients underwent liver lobectomy by the same team and were divided into two groups according to whether there was recurrence during the 2-year postoperative follow-up period.Among them,there were 34 cases in the recurrence group and 203 cases in the non-recurrence group.Using binary Logistic regression analysis to identify risk factors for postoperative recurrence of liver and bile duct stones,and constructing a predictive model based on the results of binary Logistic regression.Using ROC curve analysis to evaluate the diagnostic efficacy of the predictive model,and verifying its validity.Results Univariate analysis showed that age,BMI,course of disease,gender,common bile duct exploration,cholecystectomy,hypertension,diabetes,hepatitis and cirrhosis,smoking,drinking history in the recurrence group were not statistically significant compared with those in the non recurrence group (P>0.05),while the size of stones in the liver,diameter of common bile duct,number of stones,biliary inflammation,biliary stricture,diverticulum near the nipple,residual stones,hypercholesterolemia in the recurrence group were statistically significant compared with those in the non recurrence group (P<0.05).Logistic multiple regression analysis showed that intrahepatic stone size ≥ 10mm,number of stones>1,biliary inflammation,biliary stricture,and diverticulum adjacent to the nipple were risk factors for postoperative recurrence of hepatobiliary stones [OR values (95%CI) were 5.032 (1.812-13.977),2.585 (1.007-6.632),2.512 (1.013-6.230),4.571 (1.775-11.72),2.925 (1.023-8.363),P<0.05].Based on the risk factors,a prediction model was constructed.The Hosmer-Lemeshow fitting test showed that χ²=3.506,P=0.743.Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) of the prediction model for recurrence after hepatobiliary calculi surgery was 0.828,the Youden index was 0.489,and the sensitivity and specificity were 76.5% and 72.4%,respectively.95%CI was (0.756,0.906).The accuracy was 88.2%.Conclusion The risk prediction model for postoperative recurrence of liver and gallbladder stones constructed in this study has certain predictive value.

Key words: surgery for liver and bile duct stones, postoperative recurrence, risk model, validation research