关键词: 肝切除术, 腹腔镜, 危险因素, 中转开放手术, 列线图模型

Abstract: Analysis of risk factors and establishment of risk prediction model for conversion to open surgery in laparoscopic hepatectomy        HUANG Shao-jian, LI Zhi-xi, LIANG Han-biao, et al. Department of Hepatobiliary and Pancreatic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510000, China
Corresponding author: Li Chuan-jiang, E-mail: licj76@163.com
Abstract    Objective    To investigate the risk factors of conversion to laparotomy during laparoscopic hepatectomy and establish a risk prediction model for the conversion. Methods    Clinical case information of 938 patients undergoing laparoscopic hepatectomy admitted to the Department of Hepatobiliary Surgery, Nanfang Hospital of Southern Medical University from June 2019 to May 2022 was retrospectively analyzed. The patients were divided into laparoscopic group(836 cases) and conversion group(102 cases) according to whether were transferred to open surgery. Basic information and clinical case data of all included patients were collected. The differences between the two groups and their factors were analyzed, and R language was used to establish and evaluate the prediction model of conversion nomograms based on the results of multi-factor analysis. Results    The results of single-factor analysis showed that: Between the two groups of comparisons, there were statistically significant differences in the history of abdominal surgery, history of vascular interventional therapy, being or being not the first hepatic resection, presence or absence of ascites, the maximum diameter of liver tumor, difficult location hepatectomy and resection scope (P < 0.05). The results of multi-factor analysis showed that: History of abdominal surgery (OR=1.716, 95%CI 1.023-2.878), non-first-time hepatectomy (OR=3.585, 95%CI 1.705-7.538), maximum diameter of liver tumor ≥5cm (OR=2.680,95%CI 1.646-4.363), difficult location hepatectomy (OR=2.953,95%CI 1.755-4.967), and scope of hepatectomy ≥3 liver segments (OR=1.901，95%CI1.099-3.290) were independent risk factors for conversion to laparotomy during laparoscopic hepatectomy (P < 0.05). According to the results of multivariate analysis, including the five independent risk factor variables, the nomogram prediction model of laparoscopic liver resection converted to laparotomy was constructed. The C-index of the model was 0.746 (95%CI 0.692-0.800), the P value of Hosmer and Lemeshow Test was 0.541＞0.05, ROC curve was drawn, and the area under the curve(AUC) was 0.746 (95%CI 0.692-0.800, P < 0.001). The results of the decision curve analysis (DCA) showed that the model had clinical utility in the threshold probability range of 0.05-0.70. Conclusion History of abdominal surgery, non-first-time hepatectomy, maximum diameter of liver tumor ≥5cm, resection of liver segments at difficult sites, and resection scope of liver segments ≥3 segments are independent risk factors for conversion to open surgery during laparoscopic hepatectomy. The calibration curve of the nomogram prediction model constructed based on this method has a good degree of fitting, and the predicted conversion rate is in good agreement with the actual conversion rate, and the nomogram prediction model has good prediction ability. However, it still needs to be further verified by external verification

Key words: hepatectomy, laparoscope, risk factors, conversion to open surgery, nomogram model