目的 探讨经脐单孔腹腔镜和传统腹腔镜全子宫切除术患者手术并发症的共同影响因素及预测模型构建。 方法 选取2021年9月至2024年12月于贵州省人民医院因良性妇科病变行经脐单孔或传统腹腔镜全子宫切除术的585例患者为研究对象，收集患者临床资料，按照7∶3比例划分为训练集和验证集。在训练集中分别用LASSO-logistic回归、全变量logistic回归及逐步logistic回归模型筛选并发症影响因素，整合曲线下面积（AUC）、Akaike信息准则（AIC）/贝叶斯信息准则（BIC）、净重分类指数（NRI）/综合判别改善指数（IDI）多维度评估模型效能并开发网页列线图工具，最终经验证集验证其区分度、校准度与临床适用性。结果 术前中重度贫血、剖宫产史、高血压及子宫>12孕周为独立危险因素，LASSO-logistic回归模型具有较好预测性能[AUC=0.792（95%CI 0.736~0.849），AIC =341.059 ，BIC = 374.115，NRI>0，IDI>0]。验证集AUC=0.786（95%CI 0.725~0.845）。校准曲线显示模型预测与实测风险吻合良好。决策曲线表明当风险阈值>0.04时，模型可提供临床净收益（训练集阈值范围0.07~0.98，验证集0.04~0.97）。结论 术前贫血、剖宫产史、高血压和子宫大小是经脐单孔腹腔镜或传统腹腔镜全子宫切除手术并发症的共同影响因素。LASSO-logistic回归模型具有一定临床预测价值。

Objective To investigate the influencing factors of surgical complications in patients undergoing transumbilical single-port laparoscopic total hysterectomy and traditional laparoscopic total hysterectomy and to construct a prediction model. Methods The clinical data of patients undergoing transumbilical single-port or traditional laparoscopic total hysterectomy for benign diseases at Guizhou Provincial People's Hospital from September 2021 to December 2024 were retrospectively collected. The data were divided into a training set (n=409) and a validation set (n=219). LASSO-logistic regression，full-variable logistic regression，and stepwise logistic regression models were applied to screen for influencing factors in the training set. Model performance was evaluated in multiple dimensions using the area under the receiver operating characteristic curve (AUC)，Akaike information criterion (AIC)/Bayesian information criterion (BIC)，net reclassification index (NRI)/integrated discrimination improvement index (IDI)，and a nomogram was developed. The validation set was used to assess its discrimination，calibration，and clinical applicability. Results Moderate to severe preoperative anemia，history of cesarean delivery，hypertension，and uterine size >12 gestational weeks were identified as independent risk factors. The LASSO-logistic regression model demonstrated optimal predictive performance [AUC=0.792 (95%CI 0.736-0.849)；AIC=341.059；BIC=374.115；NRI > 0；IDI > 0]. Validation yielded an AUC of 0.785 (95%CI 0.700-0.870). Calibration curves showed good consistency between predicted and observed risks. Decision curve analysis confirmed clinical net benefit at risk thresholds >0.06 (training set：0.07-0.98；validation set：0.06-0.86). Conclusions Preoperative anemia，history of cesarean section，hypertension，and uterine size are identified as influencing factors for complications in laparoscopic total hysterectomy. The LASSO-logistic regression model demonstrates certain clinical prediction value.