Analysis of factors influencing stone recurrence and establishment of risk prediction model after lapa-roscopic common bile duct exploration combined with laparoscopic cholecystectomy
Analysis of factors influencing stone recurrence and establishment of risk prediction model after lapa-roscopic common bile duct exploration combined with laparoscopic cholecystectomy
Objective To explore the risk factors for stone recurrence after laparoscopic common bile duct exploration(LCBDE)combined with laparoscopic cholecystectomy(LC)and to develop a risk prediction model.Methods Clinical data of 344 patients with bile duct stones who underwent LCBDE com-bined with LC at Hebei General Hospital from January 2016 to March 2022 were retrospectively analyzed,including 165 males and 179 females,aged(62.72±13.56)years old.Patients were divided into two groups based on whether stones recurred during the follow-up period:recurrence group(n=37)and non-recurrence group(n=307).Clinical data such as common bile duct diameter,stone size,number of stones and duration of T-tube drainage were collected from the patients.Logistic regression was used to analyze the risk factors for postoperative stone recurrence,and then developed a logistic regression model.The predictive efficacy of the model was assessed by the area under the receiver operating characteristic(ROC)curve,and the Hosmer-Lemeshow test.Results The results of multifactorial logistic regression analysis showed that patients with ≥2 choledochal stones had a high risk of stone recurrence after LCBDE combined with LC(OR=3.094,95％CI:1.069-8.954,P=0.037).In contrast,regular postoperative oral choleretic medication was a protective factor for stone recurrence after LCBDE combined with LC(OR=0.160,95％CI:0.072-0.354,P=0.001).A logistic regression model,based on the number of common bile duct stones and regular postoperative oral choleretic medication,was developed to predict the recurrence of bile duct stones in patients who underwent LCBDE combined with LC.The area under the ROC curve for this model was found to be 0.821(95％CI:0.758-0.885).The Hosmer-Lemeshow test,x2=7.26,P=0.509,suggested that there is good agreement between the model's predicted probabilities and ideal probabili-ties.Conclusions The number of stones(≥2)is an independent risk factor for stone recurrence after LCBDE combined with LC in patients with bile duct stones.Regular postoperative oral choleretic medication is a protective factor for stone recurrence after LCBDE combined with LC.Predictive models based on the number of choledochal stones and regular postoperative oral choleretic medication have better efficacy in pre-dicting postoperative stone recurrence.
维普
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