关键词: 原发性肝癌, 胆漏, 风险预测模型, 病灶直径, 肝功能, 胆管炎, 余肝体积, 出血量

Abstract: Objective To establish a risk prediction model of biliary fistula in patients with primary liver cancer(PHC) after laparoscopic hepatectomy(LH).
Methods 100 patients with PHC admitted to the hospital from January 2016 to January 2021 were prospectively selected as the research subjects,the baseline data were collected,treated with LH,the occurrence of postoperative biliary fistula of patients was recorded,they were divided into a biliary fistula group and a non biliary fistula group,baseline data and operation related variables were compared between the two groups,regression analysis test was used to examine the risk factors of biliary fistula after LH,the risk prediction model of biliary fistula was established,Hosmer-Lemeshow goodness of fit test was used,and the ROC curve was drawn,the predictive efficiency of risk prediction model of biliary fistula on biliary fistula after LH was evaluated.
Results Among the 100 patients with PHC after LH,11 cases developed biliary fistula,and 89 cases did not;after preliminary comparison of baseline data and operation related variables between biliary fistula group and non biliary fistula group,through single Logistic regression analysis,the results showed that lesion diameter,high alanine aminotransferase(ALT),aspartate aminotransferase(AST),combined with preoperative cholangitis and intraoperative blood loss were the risk factors of postoperative biliary fistula after LH(OR>1,P＜0.05);the high volume of remaining liver was the protective factor of biliary fistula after LH(OR<1,P＜0.05);ROC curve was drawn and  showed that AUC of biliary fistula risk prediction model used to predict the risk of biliary fistula after LH were >0.80,which had certain predictive value;on the basis of the original study population,the bootstrap method was used to resample 100 times,the internal validation population was obtained,the established risk prediction scoring system was used to assess the risk of patients in the internal validation population,the results showed that Hosmer-Lemeshow goodness of fit test P was >0.05,fitting had no significant difference,fitting with satisfaction.
Conclusion There are many risk factors for biliary fistula in PHC patients after LH,according to multiple risk factors,the risk prediction model is established,which has certain efficiency in predicting the risk of postoperative biliary fistula.

Key words: primary liver cancer, biliary fistula, risk prediction model, lesion diameter, liver function, cholangitis, remnant liver volume, blood loss