| Objective To analyze the factors related to the occurrence of common bile duct stones(CBDS) after laparoscopic cholecystectomy(LC) in patients with gallstones, and to establish and validate the effectiveness of an early postoperative individualized risk assessment nomogram model. Methods Clinical data of 572 patients with gallstones who underwent LC at Fuyang Cancer Hospital from October 2019 to October 2022 were retrospectively collected. Patients were divided into a secondary group(68 cases) and a non-secondary group(504 cases) based on whether CBDS occurred after surgery. Univariate and multivariate logistic regression analyses were used to screen for independent predictive factors, and a nomogram model was constructed based on R software. Model performance was evaluated using the Bootstrap internal validation method. Discriminative ability and calibration were assessed using the concordance index(C-index), receiver operating characteristic(ROC) curve, and calibration curve, and clinical net benefit was evaluated using decision curve analysis(DCA). Results Multivariate logistic regression showed that poor dietary compliance, poor wound care quality, number of stones ≥3, and a history of neck or ampullary incarceration were independent risk factors for secondary CBDS after LC(P<0.05), while larger stone diameter was an independent protective factor. The C-index of the constructed nomogram model was 0.821, the area under the curve(AUC) of the ROC curve was 0.832, the calibration curve showed a good fit, and DCA indicated that the model had a positive net benefit across a wide range of threshold probabilities. Conclusion Poor dietary compliance, poor wound care quality, multiple gallstones, and a history of neck/ampullary incarceration are independent risk factors for secondary CBDS after LC, while a larger stone diameter is an independent protective factor. The nomogram model constructed based on these above variables has good discriminative ability, calibration, and clinical net benefit. |
