Assessment Of Serious Complications And Risk Factors After Hepatectomy For Intrahepatic Bile Duct Stones Based On Clavien-Dindo Grading System

Objective: The Clavien-Dindo grade of postoperative complications after hepatectomy for intrahepatic bile duct stones was performed to analyze the risk factors associated with serious postoperative complications,and to establish a prediction model for the Nomogram of serious postoperative complications,so as to provide a theoretical basis for clinical workers to better predict and treat serious postoperative complications after hepatectomy for intrahepatic bile duct stones.Methods: Retrospective analysis of clinical data related to patients with intrahepatic bile duct stones who underwent hepatectomy at the Zunyi Medical University Hospital from January 2012 to December 2020.According to inclusion and exclusion criteria,the data of 331 patients included in the statistics were randomly divided into two groups by random number table method in the ratio of 7:3,namely modeling group(n=232)and validation group(n=99).The modeling group was further divided into 183 cases in the non-severe complication group(Clavien-Dindo grade I-II)and 49 cases in the severe complication group(Clavien-Dindo grade III-V)based on the Clavien-Dindo grading system,and the potential risk factors in the general,preoperative,intraoperative,and postoperative data were screened by using univariate analysis.Independent risk factors for the development of serious complications after hepatectomy for intrahepatic choledocholithiasis were obtained by using multifactorial logistic regression analysis.A postoperative serious complication Nomogram prediction model was constructed by using R software to predict the risk of serious complications after hepatectomy for intrahepatic choledocholithiasis.The discrimination and calibration of the prediction model were assessed by using the subject operating characteristic(ROC)curve and the Calibration calibration curve.Results:(1)Postoperative complications in the modeling group were quantified and graded based on the Clavien-Dindo grading system,and the results were as follows: 112patients(48.3%)had Clavien-Dindo I complications,71 patients(30.6%)had Clavien-Dindo II complications,38 patients(16.4%)had Clavien-Dindo III complications,11 patients(4.7%)had Clavien-Dindo V complications,and 0 patients had Clavien-Dindo V complications.38(16.4%),Clavien-Dindo IV complications in 11 cases(4.7%),and Clavien-Dindo V complications in 0 cases.Clavien-dindo grade III and above were classified as severe complications,with an incidence of 21.1%.The results of univariate analysis of relevant clinical data in the non-severe complication group and the severe complication group in the modeling group showed that the comparison of preoperative data between the two groups was statistically significant in terms of stone staging(P(28)0.012(8),Child-Pugh liver function classification(7)P(28)0.033(8),and ASA classification(7)P<0.001(8),and no statistically significant differences in the basic diseases history.The the comparison of intraoperative data between the two groups was statistically significant in terms of the extent of liver resection(7)P<0.001(8),bile-intestinal anastomosis(7)P(28)0.036(8),intraoperative blood transfusion(7)P(28)0.001(8),stone residual(7)P(28)0.002(8),operative time(7)P(28)0.001(8),and intraoperative bleeding(7)P<0.001(8),and no statistically significant differences in operation method.In the analysis of postoperative data,the differences in terms of DBIL(7)P(28)0.041(8)and ALB(7)P(28)0.001(8)were statistically significant.(2)Multifactorial logistic regression analysis showed that ASA classification OR(7)OR(28)8.272,95%CI:3.544-19.304,P(27)0.001(8),extent of liver resection(7)OR(28)3.755,95%CI:1.556-9.062,P(28)0.003(8),stone residual OR(28)3.125,95%CI:1.210-8.073,P(28)0.019(8)were independent risk factors for the development of serious complications after hepatectomy for intrahepatic bile duct stones.(3)To construct and validate a nomogram prediction model for severe postoperative complications: A nomogram prediction model was constructed to predict the risk of occurrence of severe postoperative complications based on independent risk factors,including ASA class III score of 100,extensive hepatectomy score of 71,and stone residual score of 60,with a risk of severe postoperative complications of approximately 10% if the total score reaches 60,and a risk of severe postoperative complications if the total score exceeds 210.The area under the Curve of ROC(AUC)values of the modeling group.The modeling group had an AUC of 0.828,a sensitivity of 71.4% and a specificity of83.1%,and the validation group had an AUC of 0.802,a sensitivity of 76.2% and a specificity of 78.2%,indicating that the prediction model of the column line graph established in this study has good discrimination;in the modeling group and the validation group,the calibration curve The calibration curves in both the modeling and validation groups were close to the standard curve,indicating that the nomogram model in this study had good calibration ability and good agreement between the predicted risk of serious postoperative complications and the actual risk.Conclusion:(1)The patients with ASA classification,extensive hepatectomy(three or more liver segments)are high risk population for serious complications after hepatectomy for intrahepatic bile duct stones,and stone residual are independent risk factors for serious complications after hepatectomy for intrahepatic bile duct stones.(2)The nomogram prediction model developed in this study has a certain amount of predictive ability to effectively predict the risk of serious complications after hepatectomy for intrahepatic choledocholithiasis.