Risk Factors and Risk Prediction Model Construction of Postoperative Bile Leakage in Patients with Hilar Cholangiocarcinoma

ZHU Bingshuai; DUAN Xibin; LIANG Zhanqiang

doi:10.3969/j.issn.1004-437X.2025.07.016

Abstract：Objective To explore the risk factors and risk prediction model of bile leakage in patients with hilar cholangiocarcinoma(HCCA)after surgery.Methods A case-control study was used to collect the clinical medical records of 32 HCCA patients with bile leakage after radical resection of cholangiocarcinoma from May 2021 to May 22 as the occurrence group,and the medical records of 64 HCCA patients without bile leakage during the same period were collected at a ratio of 1∶2 as the non occurrence group.The baseline data,clinical data and preoperative laboratory indexes were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors.The risk prediction model was constructed according to the results of logistic regression analysis,and the receiver operating characteristic(ROC)curve was drawn to evaluate the prediction efficiency.Results The age,proportion of preoperative cholangitis,and proportion of residual bile duct openings of 3 or more liver sections in the occurrence group were higher than those in the non occurrence group,and preoperative ALB levels were lower than those in the non occurrence group(P＜0.05).Logistic regression analysis showed that age,preoperative cholangitis,preoperative ALB level,and the number of residual hepatic bile duct openings of 3 or more were the influencing factors for postoperative bile leakage in HCCA patients(P＜0.05).A nomogram was drawn to construct a risk prediction model for postoperative bile leakage in HCCA patients.The discrimination of the model showed that the C-index value was 0.929,which had a good discrimination.The standard curve showed that the calibration curve was similar to the Y-X straight line,and the accuracy of the model was good.The validation of the model's predictive performance showed that the area under the curve(AUC)value of the risk prediction model for evaluating postoperative bile leakage in HCCA patients was 0.929,indicating a certain predictive performance.Conclusion Age,preoperative cholangitis,low preoperative nutritional level,and the number of residual hepatic bile duct openings are the influencing factors for postoperative bile leakage in HCCA patients.The prediction model based on the above indicators has good predictive performance.