胰十二指肠切除术后胰瘘发生的危险因素分析  

Risk factors of pancreatic fistula after pancreaticoduodenectomy

作　　者：刘巍[1] 花荣[1] 孙勇伟[1] 张军峰[1] 霍砚淼[1] 刘德军[1] 吴志勇[1] 

机构地区：[1]上海交通大学医学院附属仁济医院胆胰外科,上海200127

出　　处：《中华胰腺病杂志》2014年第5期299-302,共4页Chinese Journal of Pancreatology

摘　　要：目的 分析胰十二指肠切除术后胰瘘发生的危险因素,为临床有效降低术后并发症提供理论依据.方法 回顾性分析2009年9月至2012年9月上海交通大学医学院附属仁济医院收治的352例因癌症行胰十二指肠切除术患者的临床资料,根据术后有无发生胰瘘将患者分为胰瘘组和非胰瘘组进行对列研究.对围手术期可能影响术后发生胰瘘的多种因素进行单因素分析及多变量Logistic回归分析.结果 共49例胰十二指肠切除术后发生胰瘘,胰瘘发生率为13.9％ （49/352）.经单因素及多因素分析,术后胰瘘的发生与患者性别和年龄、糖尿病病史、手术时间、术中出血量、是否血管切除重建、胰管是否留置支撑管、胰肠吻合时间、消化道重建方式等均无关;而胰腺质地脆、胰管直径＜3 mm、术前血清总胆红素水平＞ 171 μmol/L、术前黄疸持续时间超过8周、术前血清白蛋白水平＜30 g/L是影响术后胰瘘发生的独立危险因素（P值均＜0.05）.结论 胰腺质地、胰管直径、术前黄疸程度、黄疸持续时间及低蛋白血症是影响胰十二指肠切除术后胰瘘发生的危险因素.Objective To analyze the risk factors of pancreatic fistula after pancreaticoduodenectomy,in order to provide evidence to reduce post-operative complication in clinical practice.Methods The clinical data of 352 patients with malignancy who received pancreaticoduodenectomy at the Shanghai Renji Hospital from September 2009 to September 2012 were retrospectively analyzed.The patients were divided into pancreatic fistula group and non-pancreatic fistula group.Peri-operative risk factors of pancreatic fistula after pancreaticoduodenectomy were analyzed by univariate and multivariate logistic regression analysis.Results Forty-nine cases of pancreatic fistula occurred,and the incidence rate of pancreatic fistula was 13.9％ （49/352）.Univariate and multivariate logistic regression analysis showed sex,age,history of diabetes,operation time,intra-operative blood loss,vessel reconstruction,pancreatic tube placement,anastomosis time,type of digestive tract reconstruction were not risk factors of pancreatic fistula; however,brittle pancreatic tissue,diameter of pancreatic duct ＜3 mm,pre-operative total bilirubin level ＞ 171 μmol/l,duration of preoperative jaundice ＞ 8 weeks,pre-operative albumin level ＜30 g/L were the independent risk factors of pancreatic fistula （P ＜ 0.05）.Conclusions Brittle pancreatic tissue,small pancreatic duct,high level of serum bilirubin,long duration of preoperative jaundice,low level of serum albumin are the independent risk factors of pancreatic fistula after pancreaticoduodenectomy.

关 键 词：胰十二指肠切除术 手术后并发症 胰腺瘘 危险因素 

分 类 号：R656[医药卫生—外科学]