胰十二指肠切除术后胰瘘发生风险预测系统的临床价值  

Clinical value of a preoperative predictive scoring system for postoperative pancreatic fistula after pancre-aticoduodenectomy

作　　者：张倜 李慧锴 李强 

机构地区：[1]天津医科久学附属肿瘤医院肝胆外科肿瘤研究所,300060

出　　处：《中华消化外科杂志》2013年第8期569-572,共4页Chinese Journal of Digestive Surgery

基　　金：国家教育跨新世纪优秀人才基金（2006-2009）

摘　　要：目的探讨日本国立癌症中心医院（NCCH）建立的胰十二指肠切除术后胰瘘的术前预测系统（简称NCCH预测系统）的临床价值。方法回颐性分析2008年10月至2012年1月天津医科大学附属肿瘤医院收治的100例术前诊断为壶腹周同肿瘤干亍胰十二指肠切除术患者的临床资料。NCCH预测系统纳入患者性别、胰腺癌、主胰管指数、门静脉受侵犯及腹腔内脂肪厚度5项指标，并将积分〉4分者定义为术后胰瘘高危人群；≤4分者为低危人群。对影响术后胰瘘发生的相关因素采用PearsonX2检验进行统计分析。应用ROC曲线分析NCCH预测系统对患者术后胰瘘发生的敏感度和特异度。结果本组100例患者中，20例术后发生胰瘘，其中A级9例、B级6例、C级5例。相关因素分析结果表明：性别、胰腺癌、门静脉受侵犯、胰腺质地及胰肠吻合方式等与术后胰瘘的发生密切相关（X^2=5．613，4．785，15．479，7．145，7．050，P〈0．05）。高危人群术后胰瘘发生率高达86．4％（19／22），而低危人群术后胰瘘发生率仅为1．3％（1／78），两者比较，差异有统计学意义（X^2=77．637，P〈0．05）。ROC曲线分析表明：NCCH预测系统对术后胰瘘预测的敏感度、特异度分别达到95．0％和96．3％，ROC曲线下面积达99．0％（P〈0．05）。结论NCCH预测系统能够准确地预测严重胰瘘的发生。Objective To investigate the clinical value of a preoperative predictive scoring system estab- lished by National Cancer Center Hospital （NCCH） for postoperative pancreatic fistula （POPF） after pancreaticodu- odenectomy （PD）. Methods The clinical data of 100 patients with periampullary tumor who underwent PD in the Cancer Hospital of Tianjin Medical University from October 2008 to January 2012 were retrospectively analyzed. Five indexes including gender, pancreatic cancer, main pancreatic duct index, portal invasion and intra-abdominal fat thickness were in the NCCH preoperative predictive scoring system. Patients with score 〉 4 were defined as with high risk of POPF, and those with score ≤4 were defined as with low risk of POPF. Factors associated with POPF were analyzed using the Pearson chi-square test. The sensitivity and specificity of the predictive scoring system were determined by receiver operating characteristic （ROC） curve analysis. Results Of the 100 patients, 20 had POPF, including 9 in grade A, 6 in grade B and 5 in grade C. Gender, pancreatic cancer, portal invasion, texture of pancreas and method of pancreaticojejunostomy were closely correlated with POPF （X^2=5. 613, 4. 785, 15. 479, 7. 145, 7. 050, P 〈 0.05 ）. The incidence of POPF was 86.4% （19/22） for patients with high risk of POPF, and 1.3% （1/78） tor patients with low risk of POPF, with significant difference （X^2 = 77. 637, P 〈 0. 05 ）. The results of ROC curve analysis showed that the sensitivity and specificity of the predictive scoring system were 95.0% and 96.3% , respectively. The nomogram showed an area under the curve of 99.0% （P 〈 0.05）. Conclusion The NCCH preoperative predictive scoring system could accurately predict the occurrence of POPF.

关 键 词：腹壶周围疾病 胰十二指肠切除术 胰瘘 预测 

分 类 号：R735[医药卫生—肿瘤]