术前超声检查预测急性胆囊炎腹腔镜手术难度的受试者工作特征曲线分析

目的探讨术前超声检查对急性胆囊炎行腹腔镜手术难度的预测价值。方法对235例急性胆囊炎腹腔镜胆囊切除术(LC)患者术前行腹部超声检查,记录胆囊容积,胆囊壁厚度,胆囊窝有无积液,胆囊颈管是否有结石嵌顿,胆囊与周围粘连,胆囊三角粘连情况。应用χ2检验单因素分析筛选出导致手术困难的危险因素,再对危险因素进行Logistic多元回归分析,并分别赋值,建立术前超声预测急性胆囊炎LC难度评分表,进行受试者工作特征(re-ceiver operator characteristic,ROC)曲线分析。结果胆囊容积增大、胆囊壁增厚、胆囊颈管结石嵌顿和胆囊颈粘连是影响急性胆囊炎腹腔镜手术难度的独立危险因素。应用4项指标建立术前超声预测急性胆囊炎LC难度评分表。经ROC曲线分析,曲线下面积为0.945,与完全随机情况下获得的曲线下面积(0.5)进行比较,差异有统计学意义(P<0.05)。结论术前超声检查可以较好地预测急性胆囊炎行腹腔镜手术的难易程度,对手术适应证的选择有重要指导意义。

Evaluation of Ultrasonic Predicting Difficulty of Laparoscopic Cholecystectomy in Acute Cholecystitis by Receiver Operator Characteristic Curve

Objective To explore the predictive value of ultrasonic appearance for difficulty of laparoscopic cholecystectomy(LC) in acute cholecystitis.Methods A total of 235 patients with acute cholecystitis received ultrasonic examination before LC.The parameters were measured pre-operation including the volume of gallbladder,cholecystic wall thickness,gallbladder fossa fluid,stone incarceration and adhesion of gallbladder or Calot′s triangle.The risk factors associated with difficult LC was selected by Chi-square test,then multivariable analysis with Logistic regression was performed for the selected risk factors and given scores which formed a scoring system for ultrasonic appearance in acute cholecystitis,predicting technical difficulties during LC.Receiver operator characteristic(ROC) curve was then applied to analyze the scoring system.Results Multivariate analysis showed that enlarged gallbladder,cholecystic wall thickness,stone incarceration in cholecystic neck and adhesion of Calot′s triangle were independent risk factors for difficulties during LC.A scoring system for predicting the difficulty level of LC in patients with acute cholecystitis was then established.The ROC curve analysis revealed that area under the curve(AUC) was 0.945,which was statistically higher than 0.5,the AUC from randomizing scheme(P<0.05).Conclusion Preoperative ultrasonography in patients with acute cholecystitis is a good predictor of difficulty in LC,and has an important significance for selection of laparoscopic operation in acute cholecystitis.