肝内胆管结石患者术后感染性并发症风险模型的建立与验证
Establishment and Validation of a Risk Model for Postoperative Infectious Complications in Patients with Intrahepatic Bile Duct Stones

目的：探讨肝内胆管结石患者术后感染性并发症相关危险因素并建立预测模型方法：回顾性分析2012年1月~2023年6月收治的接受手术治疗并行术中胆汁培养的165例肝内胆管结石患者，根据是否发生术后感染分为感染组和非感染组，分析术后感染的危险因素。通过单因素分析和多因素Logistic回归分析术后感染的危险因素，并建立列线图预测模型，以C-index评估模型的区分度，用校准图、Hosmer-Lemeshow拟合优度检验评估模型拟合程度，决策曲线分析法(DCA)、临床影响曲线(CIC)评估模型的临床实用性。结果：术后感染率达36.4%，通过单因素分析，提示年龄、术前ALB水平、肝叶(段)萎缩、手术时间、是否行第一肝门阻断在两组患者两两比较有统计学意义(P < 0.05)；多因素Logistic分析示肝叶(段)萎缩(OR = 1.423, 95%CI: 1.195~1.918, P = 0.029)、术前ALB水平低(OR = 0.908, 95%CI: 0.842~0.981, P = 0.014)、手术时间长(OR = 1.242, 95%CI: 1.008~1.531, P = 0.042)与术后感染显著相关。结论：肝叶(段)萎缩、术前白蛋白水平低、手术时间长是肝内胆管结石术后感染的独立危险因素，模型能够较为准确的预测肝内胆管结石患者术后感染性并发症，临床实用性较好。
Objective: Exploration of risk factors associated with postoperative infectious complications in pa-tients with intrahepatic bile duct stones and development of a prediction model. Methods: Retro-spective analysis of 165 patients with intrahepatic bile duct stones who underwent surgical treat-ment with intraoperative bile culture admitted from January 2012 to June 2023 were divided into infected and non-infected groups according to the occurrence of postoperative infections, and the risk factors of postoperative infections were analysed. The risk factors for postoperative infection were analysed by univariate analysis and multifactorial logistic regression, and a column-line graphical prediction model was developed to assess the discrimination of the model by C-index, the degree of model fit was assessed by calibration plot, Hosmer-Lemeshow goodness-of-fit test, and the clinical utility of the model was assessed by Decision Curve Analysis (DCA), Clinical Impact Curve (CIC). Results: The postoperative infection rate reached 36.4%, which suggested that age, preopera-tive ALB level, hepatatrophy, operation time, and hepatic portal block were statistically significant in two groups of patients compared two by two by one by one by univariate analysis (P < 0.05); mul-tifactorial logistic analysis showed that hepatatrophy (OR = 1.423, 95%CI: 1.195~1.918, P = 0.029), preoperative low ALB level (OR = 0.908, 95%CI: 0.842~0.981, P = 0.014), and long operation time (OR = 1.242, 95%CI: 1.008~1.531, P = 0.042) were significantly associated with postoperative in-fection. Conclusion: Hepatatrophy, low preoperative albumin level, and long operation time are in-dependent risk factors for postoperative infection of intrahepatic bile duct stones, and the model can more accurately predict postoperative infectious complications in patients with intrahepatic bile duct stones, which has good clinical utility.