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目的:探讨腹腔镜胆囊切除术(LC)联合腹腔镜胆总管探查术(LCBDE)治疗胆囊结石合并胆总管结石的术前危险因素，建立预测中转开腹的列线图模型。方法:回顾性分析沧州市人民医院2015年1月1日—2019年12月31日309例行LC联合LCBDE患者的临床资料，根据是否中转开腹分为未开腹组290例，开腹组19例。通过单因素及多因素Logistic回归分析得到中转开腹的独立预测因素，应用RStudio建立列线图模型并对其进行验证。结果:单因素分析结果表明腹部手术史、BMI、白细胞、中性粒细胞比率、碱性磷酸酶、血清总胆红素、胆囊壁厚度、胆总管直径及胆总管下段结石嵌顿是LC联合LCBDE发生中转开腹的相对危险因素(n OR＝0.195，0.369，0.287，0.241，0.237，0.082，0.166，0.198，0.190；95%n CI：0.073～0.517，0.114～1.195，0.096～0.859，0.085～0.682，0.092～0.613，0.023～0.287，0.058～0.475，0.073～0.537，0.056～0.649)；多因素Logistic回归分析显示，白细胞>10×10n 9/L、碱性磷酸酶>150 U/L、血清总胆红素>17.1 umol/L、胆囊壁厚度>4 mm、胆总管直径>12 mm、胆总管下段结石嵌顿是LC联合LCBDE中转开腹的独立预测因素(n OR＝6.498，3.656，22.160，5.762，4.849，7.916；95%n CI：1.434～29.442，1.095～12.203，4.485～109.496，1.491～22.262，1.384～16.988，1.366～45.884)。基于独立预测因素建立列线图模型，随后采用Bootstrap重复抽样对预测模型进行内部验证，校正曲线发现预测模型一致性良好，C-index为0.924(95%n CI：0.857～0.990)，受试者工作特征(ROC)曲线下面积为0.924(95%n CI：0.855～0.992)，说明预测模型准确性高。n 结论:基于胆总管下段结石嵌顿、胆囊壁厚度、胆总管直径、白细胞、碱性磷酸酶及血清总胆红素因素建立的列线图模型预测LC联合LCBDE中转开腹能力较好，临床应用价值高。“,”Objective:To explore the preoperative risk factors of laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE) in the treatment of cholecystolithiasis combined with choledocholithiasis, and establish a nomogram model to predict the transition to laparotomy.Methods:A retrospective analysis of the clinical data of 309 patients undergoing surgery in Cangzhou People′s Hospital from January 1, 2015 to December 31, 2019, were divided into 290 cases in non-laparotomy group and 19 cases in laparotomy group whether they were transferred to laparotomy. Obtained independent predictors of transition to laparotomy through univariate analysis and multivariate logistic regression analysis, and used RStudio to establish a nomogram model to verify it.Results:The results of univariate analysis showed that the history of abdominal surgery, BMI, white blood cell, neutrophil ratio, ALP, serum total bilirubin, gallbladder wall thickness, common bile duct diameter, and lower common bile duct stone incarceration were relative risk factors of LC combined with LCBDE for conversion to laparotomy (n OR=0.195, 0.369, 0.287, 0.241, 0.237, 0.082, 0.166, 0.198, 0.190; 95%n CI: 0.073-0.517, 0.114-1.195, 0.096-0.859, 0.085-0.682, 0.092-0.613, 0.023-0.287, 0.058-0.475, 0.073-0.537, 0.056-0.649). Multivariate logistic regression analysis showed that white blood cells>10×10n 9/L, alkaline phosphatase>150 U/L, serum total bilirubin>17.1 umol/L, gallbladder Wall thickness> 4 mm, common bile duct diameter>12 mm, and lower common bile duct stone incarceration were independent predictors of LC combined with LCBDE for conversion to laparotomy (n OR=6.498, 3.656, 22.160, 5.762, 4.849, 7.916; 95%n CI: 1.434-29.442, 1.095-12.203, 4.485-109.496, 1.491-22.262, 1.384-16.988, 1.366-45.884). The nomogram model was established based on independent predictors, and then bootstrap repeated sampling was used to internally verify the predictive model. The calibration curve found that the model was in good agreement, with a C-index of 0.924(95%n CI: 0.857-0.990) and the area under the receiver operating characteristics curve was 0.924(95%n CI: 0.855-0.992), indicating the high accuracy of the model.n Conclusion:The nomogram model established based on the factors of lower common bile duct stone incarceration, gallbladder wall thickness, common bile duct diameter, common bile duct diameter, white blood cells, alkaline phosphatase, and serum total bilirubin has good ability to predict conversion to laparotomy of LC combined with LCBDE, and has high clinical application value.