探讨外伤性脾破裂腹腔镜脾切除术患者中转开腹的影响因素，并构建风险预测模型。

回顾性分析2019年6月至2022年6月第九〇九医院收治的62例外伤性脾破裂患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男47例，女15例；年龄29~51岁，中位年龄41岁。Ⅱ级脾外伤17例，Ⅲ级脾外伤35例，Ⅳ级脾外伤10例。患者术中中转开腹14例。术中中转开腹影响因素分析采用χ²检验和多因素Logistic回归分析，构建中转开腹预测模型，绘制ROC曲线分析该模型对中转开腹风险的预测效能。

单因素分析显示，BMI≥27 kg/m²、损伤分级Ⅳ级、高年资主治医师主刀、术中脾损伤、暴露不佳的患者中转开腹率明显升高（χ²=7.468，15.336，5.124，15.849，12.111；P<0.05）。多因素分析显示，高年资主治医师主刀、术中脾损伤、暴露不佳是术中中转开腹的独立影响因素（HR=17.717，20.764，10.343；P<0.05）。以术中中转开腹为因变量，主刀医师年资、术中脾损伤、暴露不佳分别为自变量，构建术中中转开腹预测模型为Logit（P）=-18.980+2.875×X₁+3.033×X₂+2.336×X₃（X₁为高年资主治医师主刀，X₂为术中脾损伤，X₃为暴露不佳）。该模型预测中转开腹ROC曲线下面积为0.925，敏感度为0.857，特异度为0.854。

术者经验不足、术中脾损伤、暴露不佳是脾破裂患者腹腔镜手术失败的独立影响因素，通过构建模型可筛选适合腹腔镜手术的患者。

To investigate the influencing factors of conversion to open surgery in patients with traumatic splenic rupture undergoing laparoscopic splenectomy and to construct a risk prediction model.

Clinical data of 62 patients with traumatic splenic rupture admitted to The 909th Hospital from June 2019 to June 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 47 patients were male and 15 female,aged from 29 to 51 years, with a median age of 41 years. 17 patients were diagnosed with grade Ⅱ splenic trauma, 35 cases of grade Ⅲ splenic trauma and 10 cases of grade Ⅳ splenic trauma. Intraoperative conversion to open surgery was performed in 14 patients. The influencing factors of intraoperative conversion to open surgery were analyzed by Chi-square test and multivariate Logistic regression analysis. The prediction model for risk of conversion to open surgery was constructed. The ROC curve was drawn to analyze the prediction efficiency of this model for the risk of conversion to open surgery.

Univariate analysis showed that the conversion rate in patients with BMI≥27 kg/m², grade Ⅳ trauma, experienced attending physician as chief surgeon, intraoperative splenic injury and poor exposure was significantly increased (χ²=7.468, 15.336, 5.124, 15.849, 12.111; P<0.05). Multivariate analysis demonstrated that experienced chief surgeon, intraoperative splenic injury and poor exposure were the independent influencing factors for intraoperative conversion to open surgery (HR=17.717, 20.764, 10.343; P<0.05). Taking intraoperative conversion to open surgery as the dependent variable, and experienced chief surgeon, intraoperative splenic injury and poor exposure as the independent variables, the prediction model for risk of intraoperative conversion to open surgery was constructed as Logit(P)=-18.980+2.875×X₁+3.033×X₂+2.336×X₃ (X₁ was experienced chief surgeon, X₂ was intraoperative splenic injury, X₃ was poor exposure). The area under the ROC curve (AUC) of this prediction model was 0.925, the sensitivity was 0.857 and the specificity was 0.854.

Insufficient experience of chief surgeon, intraoperative splenic injury and poor exposure are the independent influencing factors for the failure of laparoscopic surgery in patients with splenic rupture. Eligible patients for laparoscopic surgery can be screened by constructing risk prediction models.