| Objective:This study explored the related factors of laparoscopic cholecystectomy combined(LC)with laparoscopic common bile duct exploration(LCBDE)in the treatment of cholecystolithiasis combined with choledocholithiasis,and on this basis,the nomogram model for predicting the risk of conversion to laparotomy was constructed and verified to realize the quantification of the risk of transition to laparotomy and provide guidance for clinicians to make work decisions.Methods:Using retrospective research methods,the clinical data of 523 patients with LC combined with LCBDE in Cangzhou People’s Hospital from January2014 to January 2019 were selected and gender,age,abdominal surgery history,white blood cell,neutrophil ratio,total bilirubin,alanine aminotransferase,aspartate aminotransferase,glutamyl transpeptidase,alkaline phosphatase,common bile duct diameter,gallbladder wall thickness,gallbladder enlargement,gallbladder data on the number of stones in the common duct and the incarceration of stones in the lower part of the common bile duct were collected.And they were divided into 452 cases in the laparoscopic group and71 cases in the converted laparotomy group according to whether they were transferred to laparotomy.The SPSS25.0 statistical software was used to screen out the relative risk factors for conversion to laparotomy through single factor analysis,and the statistically significant factors in the univariate analysis were incorporated into the multivariate logistic regression analysis to establish independent risk factors for conversion to laparotomy,and the independent risk factors were used based on the RStudio(1.3.1056)software to establish the nomogram model for predicting LC combined with LCBDE in the treatment of gallbladder stones combined with common bile duct stones converted to laparotomy,and verified it by the consistency index(C-index),calibration curve and receiver operating characteristics(ROC)curve.Result:1.Univariate analysis showed that abdominal surgery history(c~2=3.930,P=0.047),white blood cell>10’10~9/L(c~2=7.298,P=0.007),neutrophilratio>70%(c~2=4.267,P=0.039),total bilirubin>17.1umol/L(c~2=18.444,P<0.001),ALP>150U/L(c~2=3.877,P=0.049),common bile duct diameter>12mm(c~2=8.918,P=0.003),gallbladder wall thickness>4mm(c~2=9.084,P=0.003),and stone incarceration in the lower part of the commonbile duct(c~2=9.424,P=0.002)were all statistically significant(P<0.05),which were relative risk factors of LC combined with LCBDE for the conversion to laparotomy.2.Multivariate logistic regression analysis showed that white blood cells>10’10~9/L(OR=2.027,P=0.025),neutrophil ratio>70%(OR=2.069,P=0.023),total bilirubin>17.1umol/L(OR=2.880,P<0.001),common bile duct diameter>12mm(OR=1.844,P=0.023),stone incarceration at the lower end of the common bile duct(OR=2.505,P=0.007)were all statistically signific-ant(P<0.05),which were independent risk factors of LC combined with LCBDE for the conversion to laparotomy.3.The nomogram prediction model was established based on independent risk factors,and then Bootstrap 1000 repeated sampling was used to internally verify the prediction model.The calibration curve found that the prediction model had good consistency,with a C-index of 0.715(95%CI:0.650～0.780).The area under the ROC curve was 0.715(95%CI:0.650～0.780),indicating that the prediction model was highly accurate.Conclusion:This study screened out the independent risk factors of LC combined with LCBDE for conversion to laparotomy,and based on the lower common bile duct stone incarceration,common bile duct diameter,white blood cell,neutrophil ratio and total bilirubin we established the nomogram model,which had a good ability to predict LC combined with LCBDE for conversion to laparotomy,which provided a reliable and objective theoretical basis for clinicians to evaluate the patient’s condition and formulate individual treatment strategies. |
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