探讨复发性肝内胆管结石患者T管延迟拔除（>2个月）的影响因素，并建立Nomogram预测模型。

回顾性分析2018年1月至2021年12月在安徽医科大学第一附属医院行手术治疗并留置T管引流的180例复发性肝内胆管结石患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男54例，女126例；年龄15~85岁，中位年龄57岁。对术后留置T管延迟拔除影响因素采用单因素和多因素Logistic回归分析，基于得出的独立危险因素建立Nomogram预测模型，该模型预测价值评价采用一致性指数（C-index）、校准曲线验证和ROC曲线。

T管留置中位时间为2（1，3）个月，其中术后T管延迟拔除70例。多因素Logistic回归分析显示，肝内结石未即时清除、肝内结石双侧分布、肝内胆管狭窄、术前WBC升高、术后第1天TB≥34.2 μmol/L和胆汁培养阳性为复发性肝内胆管结石患者术后T管延迟拔除的独立危险因素（HR=2.609，2.684，5.250，4.794，4.035，2.991；P<0.05）。采用这些因素构建的Nomogram预测模型的C-index为0.800（95%CI：0.735~0.866），总分最佳截断值为134，该Nomogram模型的敏感度为0.56，特异度为0.88。

肝内结石未即时清除、肝内结石双侧分布、肝内胆管狭窄、胆管炎症和损伤为复发性肝内胆管结石患者术后T管延迟拔除的危险因素，构建的Nomogram预测模型可初步预测患者术后短期恢复效果。

To identify the influencing factors of delayed T-tube removal (>2 months) in patients with recurrent intrahepatic bile duct stones, and to establish a Nomogram prediction model.

Clinical data of 180 patients with recurrent intrahepatic bile duct stones who underwent surgery and retained T-tube drainage in the First Affiliated Hospital of Anhui Medical University from January 2018 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 54 patients were male and 126 female, aged from 15 to 85 years, with a median age of 57 years. Univariate and multivariate Logistic regression analyses were performed for the influencing factors of delayed postoperative T-tube removal. Based on the obtained independent risk factors, Nomogram prediction model was established. The prediction model was evaluated by the consistency index (C-index), calibration curve verification and ROC curve.

The median time of T-tube indwelling was 2(1,3) months. T-tube removal was delayed in 70 cases after operation. Multivariate Logistic regression analysis showed that delayed removal of intrahepatic stones, bilateral distribution of intrahepatic stones, intrahepatic bile duct steonosis, preoperative elevated WBC, TB≥34.2 μmol/Lon postoperative 1 day and positive results of bile culture were the independent risk factors for delayed T-tube removal in patients with recurrent intrahepatic bile duct stones (HR=2.609, 2.684, 5.250, 4.794, 4.035, 2.991; P<0.05). The C-index of the Nomogram prediction model constructed based upon these factors was 0.800 (95%CI: 0.735-0.866), and the optimal cut-off value of total score was 134. The sensitivity and specificity of the Nomogram model were 0.56 and 0.88, respectively.

The risk factors of delayed T-tube removal in patients with recurrent intrahepatic bile duct stones include delayed removal of intrahepatic stones, bilateral distribution of intrahepatic stones, intrahepatic bile duct stenosis, bile duct inflammation and injury. The Nomogram prediction model can preliminarily predict the short-term postoperative recovery of patients.