胰十二指肠切除术后胰瘘发生的危险因素分析  

Risk factors for pancreatic fistula after pancreaticoduodenectomy

作　　者：王小龙[1] 涂彦渊[1] 王巍[1] 袁祖荣[1] 唐健雄[1] 唐文皓[1] 王伟艺[1] WANG Xiaolong TU Yanyuan WANG Wei et al(Department of General Surgery, Huadong Hospital, Fudan University, Shanghai 200040, Chin)

机构地区：[1]复旦大学附属华东医院普外科,上海200040

出　　处：《临床肝胆病杂志》2017年第1期116-120,共5页Journal of Clinical Hepatology

基　　金：国家自然科学基金青年科学基金项目(30400438)

摘　　要：目的探讨胰十二指肠切除术(PD)术后胰瘘发生的危险因素,为临床上防治PD术后胰瘘提供一定参考。方法回顾性分析2014年1月-2015年12月于复旦大学附属华东医院行PD治疗的75例患者临床资料,对胰瘘发生的相关影响因素进行分析,并比较腹腔镜PD与开腹PD术后胰瘘发生率。单因素分析采用χ2检验或Fisher's精确概率法,多因素分析采用logistic回归模型。结果 75例患者中21例(28%)发生胰瘘,A级胰瘘7例,B级胰瘘11例,C级胰瘘3例。单因素分析结果显示年龄、有无胰管扩张及术后第1天引流液淀粉酶水平是术后胰瘘发生的影响因素(χ2值分别为6.868、12.990、4.383,P值分别为0.009、<0.001、0.004)。多因素logistic回归分析表明,年龄≥65岁(95%可信区间:2.551~187.550)、胰管不扩张(95%可信区间:5.210~487.321)是PD术后胰瘘发生的危险因素(P值分别为0.005、0.001)。术后第1天腹腔引流管淀粉酶水平≥5000 U/L对术后胰瘘发生有一定预测作用。腹腔镜PD胰瘘发生率与开腹PD相比,差异无统计学意义(18.8%vs 30.5%,P>0.05)。结论对于年龄≥65岁、胰管不扩张及术后第1天引流液淀粉酶水平≥5000 U/L的患者,应尽早采取临床相关措施,避免胰瘘的发生。Objective To investigate the risk factors for pancreatic fistula after pancreaticoduodenectomy （PD）,and to provide a reference for the prevention and treatment of pancreatic fistula after PD in clinical treatment.Methods A retrospective analysis was performed for the clinical data of 75 patients who underwent PD in Huadong Hospital,Fudan University from January 2014 to December 2015.The influencing factors for pancreatic fistula were analyzed,and the incidence rate of pancreatic fistula was compared between patients undergoing laparo-scopic or open PD.The chi -square test or Fisher′s exact test was used for univariate analysis,and the logistic regression model was used for multivariate analysis.Results Of all patients,21 （28%）had pancreatic fistula,among whom 7 had grade A pancreatic fistula,11 had grade B pancreatic fistula,and 3 had grade C pancreatic fistula.The univariate analysis showed that age,presence or absence of pancreatic duct dilatation,and amylase level in drainage fluid on day 1 after surgery were influencing factors for pancreatic fistula after surgery （χ2 =6.868,12.990,and 4.383,P =0.009,P 〈0.001,and P =0.004）.The multivariate analysis showed that age ≥65 years （95%CI：2.551 -187.550,P =0.005）and absence of pancreatic duct dilatation （95%CI：5.210 -487.321,P =0.001）were risk factors for pan-creatic fistula after surgery.An amylase level of ≥5000 IU /L in drainage fluid on day 1 after surgery had a certain predictive value for the development of pancreatic fistula after surgery.There was no significant difference in the incidence rate of pancreatic fistula between patients undergoing laparoscopic or open PD （18.8% vs 30.5%,P 〉0.05）.Conclusion As for patients with an age of ≥65 years,absence of pancreatic duct dilatation,and an amylase level of ≥5000 IU /L in drainage fluid on day 1 after surgery,treatment should be given as soon as possible to avoid the development of pancreatic fistula.

关 键 词：胰十二指肠切除术 胰腺瘘 危险因素 

分 类 号：R657.5[医药卫生—外科学]