Analysis Of Factors Influencing Bleeding During Laparoscopic Hepatic Carcinoma Hepatectomy And Construction Of Intraoperative Hemorrhage Prediction Scoring System

Objective : To analyze the factors affecting intraoperative bleeding in patients undergoing laparoscopic hepatic carcinoma hepatectomy,and to establish a scoring system to predict intraoperative bleeding.Methods : A retrospective analysis of the clinical data of patients undergoing Laparoscopic hepatectomy(LH)in the Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Fujian Medical University from January 2014 to October 2018,and the abdominal cavity constructed by Yasushi et al.The refractory scoring system of spectroscopy was used as a screening criterion.A total of 241 patients with moderate or high difficulty were included in the study.The intraoperative blood loss was greater than or equal to 300 ml as the outcome index.The preoperative clinical data and intraoperative hemorrhage were analyzed by single factor logistic regression analysis.p<0.05 was considered as the result,and the variable with p<0.05 was included in the multifactor.Logistic regression analysis was performed to determine the relationship between intraoperative bleeding and variables.The predictive model of intraoperative hemorrhage was established by binary logistic regression equation,and the scoring system was established according to the risk(OR value)of each variable,and the degree of bleeding was divided into low risk and high risk.The surgical cases from October of 2018 to January 2019 were retrospectively analyzed.The same criteria were used to screen 50 for predictive validation.The receiver operating curve(ROC curve)was used to analyze the predictive effect of the scoring system.Results:Univariate logistic regression analysis and multivariate logistic regression analysis indicated that the tumor diameter was ?3cm,the liver resection range was ?3 liver segment resection,and the difficulty score was difficult.It was an independent risk factor for LH intraoperative bleeding(p=0.000,0.012,0.000)..According to the influencing factors related to intraoperative bleeding and the magnitude of its OR value as the predictor of intraoperative bleeding scoring system,the scoring score R(min)= 4 × ? + 4 × ? + 5 × ?.? is the size of the tumor,? is the extent of liver resection,and ? is difficult to score.R: 0-4 is classified as low risk,and R?5 is classified as high risk.The prediction verification results suggest that the area under the ROC curve is 0.798,the sensitivity of the prediction model is 64.00%,the specificity is 92.00%,the positive predictive value is 88.89%,the negative predictive value is 71.88%,and the diagnostic accuracy is 78%.Conclusion: The diameter of the tumor is ?3cm,the extent of hepatectomy is ?3,and the difficulty score is high.It is a high risk factor for hemorrhage during laparoscopic liver cancer resection.The hemorrhagic scoring system of laparoscopic liver cancer resection has been verified to better distinguish the risk of intraoperative bleeding,which is helpful for clinicians to pre-assess the risk of intraoperative bleeding and to assist in the improvement of surgical planning.