To investigate the risk factors associated with bile leakage after hepatectomy for intrahepatic bile duct stones, and to develop and validate a prediction model.

The clinical data of 244 patients who underwent hepatectomy for intrahepatic bile duct stones at Mianyang Central Hospital from January 2019 to December 2024 were retrospectively analyzed. There were 162 males and 82 females, aged 25-84 years, with a median age of 60 years. This study was approved by the Ethics Committee of Mianyang Central Hospital. As a non-interventional retrospective study, the requirement for informed consent was waived. Patients were divided into a bile leakage group and a non-bile leakage group according to whether bile leakage occurred after surgery. Perioperative clinical indicators were analyzed using univariate and multivariate logistic regression, and a prediction model for bile leakage was constructed. The predictive performance of the model was evaluated using the receiver operating characteristic curve and area under the curve (ROC AUC). The accuracy of the model was assessed using the Hosmer-Lemeshow test and calibration curve. Decision curve analysis (DCA) was performed to evaluate the clinical utility of the model.

Postoperative bile leakage occurred in 30 patients, with an incidence of 12.3% (30/244). Among them, grade A bile leakage accounted for 60.0% (18/30), grade B for 33.3% (10/30), and grade C for 6.7% (2/30). Multivariate logistic regression analysis showed that a history of previous upper abdominal surgery, liver cirrhosis, hepatic inflow occlusion time, non-left lateral sectionectomy, and non-anatomical hepatectomy were independent risk factors for postoperative bile leakage (OR = 3.983, 3.661, 1.070, 5.390, and 3.724, respectively; P < 0.05). A prediction model was established based on these five factors, with the following formula: Logit (P) =-7.597 + 1.382×history of previous upper abdominal surgery + 1.298×liver cirrhosis + 0.068×hepatic inflow occlusion time+1.684×non-left lateral sectionectomy + 1.315×non-anatomical hepatectomy. ROC analysis of the prediction model showed that the model had an AUC of 0.862 and a C-index of 0.862. The diagnostic sensitivity and specificity of the model were 0.808 and 0.833, respectively, indicating that its predictive results were stable and reliable. The calibration curve and Hosmer-Lemeshow test showed good accuracy of the prediction model (χ²=2.662, P = 0.954). Internal validation was performed using the bootstrap resampling method with 1 000 samples, and the results showed that the model maintained good discrimination. DCA showed that when the threshold probability ranged from 0.03 to 0.81, applying this model to patient assessment yielded a net benefit, indicating that the model has certain clinical application value.

A history of previous upper abdominal surgery, liver cirrhosis, hepatic inflow occlusion time, non-left lateral sectionectomy, and non-anatomical hepatectomy are independent risk factors for bile leakage after hepatectomy for intrahepatic bile duct stones. The prediction model constructed based on these factors has good discrimination and calibration, and can effectively assess the risk of postoperative bile leakage.