基于因果森林模型的腹腔镜肝血管瘤术式个体化选择:单中心回顾性研究OA

Objective To compare the differences in intraoperative bleeding control between laparoscopic hepatic hemangioma enucleation and hepatic resection,to identify key effect modifiers,and to provide a reference for surgical procedure selection,based on the individualized causal inference method of the causal forest(CF)model.Methods The clinical data of 196 patients with hepatic hemangioma who underwent laparoscopic surgery at the Department of Liver Surgery,West China Hospital of Sichuan University between November 2023 and November 2025 were retrospectively analyzed.According to the surgical procedures,the patients were divided into the hepatic hemangioma enucleation group(111 cases)and the hepatic resection group(85 cases).The CF model was adopted to estimate the individualized treatment effect(ITE)and average treatment effect(ATE),and subgroup analysis was performed using the median values of all split points for the key variables within the CF model as the thresholds.Subsequently,a multiple linear regression model was constructed for explanatory analysis,with intraoperative blood loss as the primary outcome variable.Results There were 111 cases of enucleation and 85 cases of resection.The overall ATE was-2.4 mL(95％CI:-86.1-81.4,P＞0.05),indicating no statistically significant difference in overall bleeding between the two surgical procedures.The ITE ranged from-53.3 to 52.6 mL,demonstrating obvious individual heterogeneity.Variable importance analysis showed that the portal venous phase enhancement ratio(PER)contributed the most.When PER≤32.58％,patients tended to benefit more from enucleation;when PER＞32.58％,resection was superior.The R2 of the linear model was 0.544,and its correlation coefficient with the CF prediction results was 0.74.Conclusion The CF model can effectively reveal individualized bleeding differences in the selection of surgical procedures for laparoscopic hepatic hemangioma.PER can serve as an important quantitative indicator for preoperative stratification and procedure matching,providing an interpretable quantitative basis for individualized surgical decision-making.