急性胆囊炎伴胆囊结石患者胆囊切除术后肠粘连风险预警模型构建OA

Objective To identify independent risk factors for intestinal adhesion based on clinical data of patients with a-cute cholecystitis with gallstones(ACG)after cholecystectomy,and to establish an effective risk warning model for intestinal adhesion based on these factors.Methods A total of 167 patients with ACG admitted to Pingxiang NO.2 People's Hospital from May 2020 to May 2023 were selected as the modeling group.According to the occurrence of intestinal adhesion after resection,the patients were divided into the occurrence group(27 cases)and the non-occurrence group(140 cases).Another 72 patients with ACG admitted to Pingxiang NO.2 People's Hospital from June 2023 to December 2024 were selected as the validation group,and they were divided into the occurrence group(n=22)and the non-occurrence group(n=50)according to whether intestinal adhesion occurred 3 months after surgery.The baseline data of the two groups in the modeling group were compared,and the independent influencing factors affecting the occurrence of intestinal adhesion were analyzed by univariate and multivariate logistic regression.Based on this,a risk warning model for intestinal adhesion was constructed,and the discrimination and calibration of the risk warning model for intestinal adhesion were evaluated using ROC curve and calibration curve.Results A total of 167 patients with ACG underwent cholecystectomy in this study,and 27 patients had intestinal adhesion after surgery,with an incidence rate of 16.18％(27/167).The results of univariate analysis showed that there were statistically significant differences in body mass index,the time of admission due to cholecystitis,the presence of hypertension,diabetes,the time of anal exhaust,the use of drainage tubes,and abdominal cavity residual infection between the two groups(P＜0.05).The results of multivariate logistic analysis showed that the presence of diabetes(β=2.620,OR=13.741,95％CI:1.409-133.980),the use of drainage tubes(β=2.542,OR=12.477,95％CI:1.656-94.032),the time of anal exhaust(β=0.344,OR=1.411,95％CI:1.149-1.732),and abdominal cavity residual infection(β=2.346,OR=10.634,95％CI:1.570-72.020)were independent risk factors for the occurrence of intestinal adhesion in patients(P＜0.05).The Hosmer-Lemeshow model test of the modeling group x2=7.793,P=0.454,with good fitting.The ROC of the warning model AUC was 0.918(95％CI:0.859-0.987),the maximum Youden index was 0.729,the sensitivity was 0.815,and the specificity was 0.914.The AUC of the validation group was 0.891(95％CI:0.789-0.993),the maximum Youden index was 0.658,the sensitivity was 0.818,and the specificity was 0.840.The warning model had good predictive value for the risk of intestinal adhesion after cholecystectomy in ACG patients.Conclusion Diabetes,the time of anal exhaust,the use of drainage tubes,and abdominal cavity residual infection are independent risk factors for the risk of intestinal adhesion after cholecystectomy in ACG patients.The construction of the risk warning model for intestinal adhesion after cholecystectomy in ACG patients has good predictive efficacy and certain clinical application value.