Medium And Long-term Follow-up Of Gallbladder Stone Recurrence After Choledochoscopic Gallbladder-preserving Cholecystolithotomy And Construction Of The Nomogram Prediction Model

ObjectiveCholedochoscopic gallbladder-preserving cholecystolithotomy(CGPC)is a controversial operation currently,may lead to adverse consequences such as postoperative stone recurrence.This study aims to analyze the risk factors of gallstone recurrence after the medium and long term CGPC,explore the feasibility and effectiveness of CGPC,construct and verify the nomogram of postoperative gallstone recurrence with patients undergoing CGPC for predict the probability of postoperative stone recurrence.To provide scientific reference for selecting suitable cases of CGPC in clinical practice to reduce postoperative stone recurrence rate.MethodsPatients undergoing CGPC in the Department of Hepatobiliary Surgery,The First Affiliated Hospital of Guangzhou Medical University from January 1,2016 to December 31,2019 were included.278 patients were screened by the inclusion criteria for clinical follow-up and analysis.Clinical follow-up of the included patients included transabdominal ultrasound to assess stone recurrence,statistics of family history,number of gallstones gallbladder function,and recurrence of postoperatice gallstones.Univariate and multivariate variable logistic regression analysis was used to explore the risk factors of postoperative stone recurrence and the results were used to construct a nomogram,the prediction model of gallstone recurrence.The performance of the nomogram was tested using the receiver operating characteristic curve(ROC)and calibration curve to assess the probability of postoperative stone recurrence in patients with CGPC.Results1.General information of patients: 240 patients were followed up,follow-up rate was 86.3%(240/278),the median follow-up time was 53.0(37-80)months,median age was 43.0(10.0～77.0)years,127 males and 113 females.A total of 35 patients had gallstone recurrence,and gallstone recurrence rate was 14.6%.2.Univariate analysis of gallstone recurrence: the related factors of gallstone recurrence in patients with CGPC showed that the number of gallstones,ejection fraction(EF)of the gallbladder and family history were the risk factors affecting gallstone recurrence after CGPC.3.Multivariate analysis of gallstone recurrence: The statistically significant factors of univariate analysis were analyzed to multivariate analysis.The results showed that the number of gallstones,EF of the gallbladder and family history were independent risk factors for postoperative gallstone recurrence.4.Establishment of gallstone recurrence prediction model: construct nomogram of gallstone recurrence after CGPC by number of gallstones,EF of the gallbladder and family history.The AUC of nomogram is 0.836(95%ci:0.764-0.909),with a certain accuracy.5.Validation of gallstone recurrence prediction model: The calibration curve showed good agreement between the predicted and observed values of the nomogram.ConclusionsIn this study,the number of gallstones,EF of gallbladder and family history were independent risk factors for postoperative gallstone recurrence after CGPC.By constructing a nomogram of gallstone recurrence after CGPC based on patient history and preoperative examination,the risk of postoperative gallstone recurrence can be predicted and quantified for patients with intention,which can help clinicians to conduct risk assessment and optimize the treatment strategy.