目的 探讨终末期肝泡型棘球蚴病(又称"肝泡型包虫病")患者接受体外肝切除联合自体移植(ex vivo liver resection and autotransplantation,ELRA)术后发生严重并发症(Clavien-Dindo 分级 Ⅲ a 级及以上者)的危险因素,并建立列线图预测模型.方法 回顾性分析2014年1月至2024年6月期间在四川大学华西医院接受ELRA手术的终末期肝泡型棘球蚴病患者的临床资料.采用logistic回归分析ELRA术后严重并发症的危险因素;使用LASSO回归筛选风险因素后建立列线图预测模型,并通过受试者操作特征曲线、校准曲线和决策曲线分析评估列线图模型预测术后严重并发症发生的效能;同时采用广义线性回归模型探索影响总手术时间的术前风险因素.检验水准α=0.05.结果 本研究共纳入132例接受了 ELRA手术的终末期肝泡型棘球蚴病患者,术后有47例(35.6％)发生了严重并发症.多因素logistic回归分析发现,门静脉主干或对侧第一门静脉分支受侵(P2型,华西-PHI分型,下同)患者较病灶同侧第一门静脉分支受侵(P1型)患者术后发生严重并发症风险更高[比值比(odds ratio,OR)和 95％可信区间(95％confidence interval,95％CI)=8.24(1.53,44.34),P=0.014],白蛋白.胆红素指数分级1级者较2级及以上者术后发生严重并发症的风险更低[OR(95％CI)=0.26(0.08,0.83),P=0.023],随着总手术时间延长及自体血回输量增加术后发生严重并发症风险增高[OR(95％CI)=1.01(1.00,1.01),P=0.009;OR(95％CI)=1.00(1.00,1.00),P=0.043].LASSO回归筛选出的2个风险因素白蛋白.胆红素指数分级和总手术时间构建的列线图预测模型对ELRA术后是否发生严重并发症的区分度良好[受试者操作特征曲线下面积(95％CI)为0.717(0.625,0.808)].广义线性回归模型分析发现门静脉侵犯程度P2型和更远的对侧第二门静脉分支受侵(P3型)及有远处转移是影响总手术时间的风险因素[P2型/P1型:β(95％CI)=110.26(52.94,167.58),P＜0.001;P3 型/P1 型:β(95％CI)=109.25(50.99,167.52),P＜0.001;远处转移有/无:β(95％CI)=61.22(4.86,117.58),P=0.035].结论 从本研究分析结果看,对门静脉侵犯程度为P2型、白蛋白-胆红素指数分级2级及以上、总手术时间长和自体血回输量多的晚期肝泡型棘球蚴病患者需要密切关注,术前严格评估第一肝门侵犯和远处转移情况,以降低ELRA术后发生严重并发症的风险.本研究基于白蛋白.胆红素指数分级和总手术时间构建的列线图预测模型展现出对术后发生严重并发症的良好预测效能,可为临床制定干预决策提供参考.
Ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis:Risk factors and prediction model for severe postoperative complications
Objective To investigate the risk factors affecting severe postoperative complications(Clavien-Dindo classification Ⅲ a or higher)in patients with end-stage hepatic alveolar echinococcosis(HAE)underwent ex vivo liver resection and autotransplantation(ELRA),and to develop a nomogram prediction model.Methods The clinical data of end-stage HAE patients who underwent ELRA at the West China Hospital of Sichuan University from January 2014 to June 2024 were retrospectively analyzed.The logistic regression was used to analyze the risk factors affecting severe postoperative complications.A nomogram prediction model was established basing on LASSO regression and its efficiency was evaluated using receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis.Simultaneously,a generalized linear model regression was used to explore the preoperative risk factors affecting the total surgery time.Test level was α=0.05.Results A total of 132 end-stage HAE patients who underwent ELRA were included.The severe postoperative complications occurred in 47(35.6％)patients.The multivariate logistic analysis results showed that the patients with invasion of the main trunk of the portal vein or the first branch of the contralateral portal vein(type P2)had a higher risk of severe postoperative complications compared to those with invasion of the first branch of the ipsilateral portal vein(type P1)[odds ratio(OR)and 95％confidence interval(CI)=8.24(1.53,44.34),P=0.014],the patients with albumin bilirubin index(ALBI)grade 1 had a lower risk of severe postoperative complications compared to those with grade 2 or higher[OR(95％CI)=0.26(0.08,0.83),P=0.023].Additionally,an increased total surgery time or the autologous blood reinfusion was associated with an increased risk of severe postoperative complications[OR(95％CI)=1.01(1.00,1.01),P=0.009;OR(95％CI)=1.00(1.00,1.00),P=0.043].The nomogram prediction model constructed with two risk factors,ALBI grade and total surgery time,selected by LASSO regression,showed a good discrimination for the occurrence of severe complications after ELRA[area under the ROC curve(95％CI)of0.717(0.625,0.808)].The generalized linear regression model analysis identified the invasion of the portal vein to extent type P2 and more distant contralateral second portal vein branch invasion(type P3),as well as the presence of distant metastasis,as risk factors affecting total surgery time[β(95％CI)for type P2/type P 1=110.26(52.94,167.58),P＜0.001;β(95％CI)for type P3/type Pl=109.25(50.99,167.52),P＜0.001;β(95％CI)for distant metastasis present/absent=61.22(4.86,117.58),P=0.035].Conclusions From the analysis results of this study,for the end-stage HAE patients with portal vein invasion degree type P2,ALBI grade 2 or above,longer total surgery time,and more autologous blood transfusion need to be closely monitored.Preoperative strict evaluation of the first hepatic portal invasion and distant metastasis is necessary to reduce the risk of severe complications after ELRA.The nomogram prediction model constructed based on ABLI grade and total surgery time in this study demonstrates a good predictive performance for severe postoperative complications,which can provide a reference for clinical intervention decision-making.
ex vivo liver resection and autotransplantationhepatic alveolar echinococcosisliver hydatid diseasesevere postoperative complicationsrisk factorsprediction model
万方数据
维普
