中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (05): 589-595.DOI: 10.19538/j.cjps.issn1005-2208.2025.05.20

• 论著 • 上一篇    下一篇

腹腔镜肝切除术后肺部并发症发生风险预测模型构建及验证

陈灿辉，王小振，梁汉标，廖乐毅，王    恺，李川江   

  1. 南方医科大学南方医院普通外科学肝胆胰外科，广东广州 510000 
  • 出版日期:2025-05-01 发布日期:2025-05-28

  • Online:2025-05-01 Published:2025-05-28

摘要： 目的    探究腹腔镜肝切除术后发生肺部并发症的危险因素，建立术后肺部并发症（PPCs）风险预测模型。方法    回顾性分析2023年1月至2024年5月南方医科大学南方医院肝胆外科收治500例行腹腔镜肝切除术病人的临床病例资料，根据术后是否发生PPCs，分为对照组（406例）和PPCs组（94例），将纳入研究病人按7∶3比例分为训练集（前70%）和验证集（后30%），通过LASSO回归筛选并分析PPCs的危险因素，并基于logistic回归构建预测模型。结果    腹腔镜肝切除术后发生PPCs的独立危险因素为慢性肺部疾病史、困难肝段切除、肝段切除数量、手术时间、术中输注胶体量、术后24 h内补液量、术后离床时间和术后气管插管拔除时间，独立保护因素为术后预防性雾化治疗。模型的C-index为0.898（95%CI 0.852-0.944），Hosmer-Lemeshow拟合优度检验P=0.2785，LASSO-logistic回归模型在验证集［受试者工作特征曲线下面积为0.863（95%CI 0.796-0.929，P＜0.001）］中具有较好的区分度及校准度，模型在临床决策曲线中，训练集阈值概率为0.02～0.90，验证集阈值概率为0.03～0.88。结论    基于LASSO-logistic回归构建的列线图模型的校准曲线拟合程度理想，在预测的PPCs发生率与实际的PPCs发生率有较好的一致性，模型具有良好的预测能力，但仍有待行外部验证来进一步证实。

关键词: 肝切除术, 腹腔镜, 术后肺部并发症, 列线图模型, LASSO-logistic回归 

Abstract: To investigate the risk factors for postoperative pulmonary complications (PPCs) following laparoscopic hepatectomy and develop a risk prediction model for PPCs. Methods    A retrospective analysis was conducted on the clinical case information of 500 patients who underwent laparoscopic hepatectomy at the Hepatobiliary Surgery Department of Nanfang Hospital, Southern Medical University, betweem January 2023 and May 2024. These patients were categorized into a control group (406 cases) and a PPCs group (94 cases) based on whether PPCs occurred postoperatively. The enrolled patients were divided into two datasets at a ratio of 7∶3, with the first 70% serving as the training set and the remaining 30% as the validation set. The risk factors for PPCs were screened and analyzed using LASSO regression, and a prediction model was constructed based on LASSO-logistic regression. Results    The independent risk factors of PPCs finally included in the prediction model were history of chronic lung disease, difficult hepatectomy, extent of hepatectomy, operation duration, intraoperative colloid infusion, postoperative fluid infusion within 24 hours, postoperative ambulation time, and postoperative tracheal intubation removal time. The independent protective factor of PPCs was postoperative preventive nebulization therapy. The C-index of the model was 0.898 (95% CI 0.852-0.944), and the Hosmer-Lemeshow goodness of fit test yielded a P value of 0.2785. The LASSO-logistic regression model demonstrated good discrimination and calibration in the validation set ［with an area under the receiver operating characteristic curve of 0.863 (95% CI 0.796-0.929, P<0.001)］. In the clinical decision curve (DCA), the threshold probability range for the training set was 0.02-0.90, and for the validation set, it was 0.03-0.88. Conclusion  The calibration curve fit of the nomogram model constructed based on LASSO-logistic regression is ideal, demonstrating good consistency between the predicted and actual incidence of PPCs. The model exhibits strong predictive power, yet it requires further external validation for confirmation.

Key words: hepatectomy, laparoscope, postoperative pulmonary complications, nomogram model, LASSO-logistic regression