胰十二指肠切除手术后早期拔除腹腔引流管对胰瘘发生及术后胰瘘出现的危险因素分析  

Risk factors of early removal of abdominal drainage tube after pancreaticoduodenectomy on pancreatic fistula and postoperative pancreatic fistula

作　　者：华志元 周永平 戴途 Hua Zhiyuan;Zhou Yongping;Dai Tu(Department of Hepatobiliary Surgery,Wuxi Second Hospital,Nanjing Medical Univeristy,Wuxi 214002,China)

机构地区：[1]南京医科大学附属无锡第二医院肝胆外科,214002

出　　处：《国际医药卫生导报》2018年第20期3052-3055,3059,共5页International Medicine and Health Guidance News

基　　金：2015年度“六大人才高峰”D类资助项目（2015-WSW076）;南京医科大学科技发展基金重点项目（2017NJMUZD117）

摘　　要：目的探讨早期拔除腹腔引流管对胰十二指肠切除手术（PD）术后胰瘘发生的影响，并分析术后胰瘘发生的危险因素。方法选择本院2014年7月至2017年7月收治81例PD患者做为研究对象，所有患者术后5d内未发生胰瘘，按受试者PD术后腹腔引流管拔除时间分为两组，A组（34例）术后5d内拔除腹腔引流管，B组（47例）术后5d后拔除腹腔引流管，比较两组患者术后并发症等发生情况，另根据术后是否出现胰瘘又分为胰瘘组和无胰瘘组，通过单因素和多因素logistic回归分析与术后胰瘘相关的危险因素。结果A组术后胰瘘、腹腔感染的发生率均明显低于对照组（11．76％比34．04％，5．88％比23．40％，均P〈0．05）；单因素分析结果显示年龄、胰腺质地、主胰管直径、手术时间、术中失血量、腹腔引流管拔除时间、肿瘤发生部位是影响PD术后胰瘘发生的相关因素，多因素logistic回归分析显示高龄、胰腺质软、手术时间长、腹腔引流管拔除时间长是影响PD术后胰瘘发生的独立危险因素。结论PD术后早期无胰瘘发生的患者于术后5d内拔除腹腔引流管可有效地减少胰瘘、腹腔感染等发生，置管时间延长会增加术后胰瘘发生的风险。Objective To explore the effect of early removal of abdominal drainage tube on pancreatic fistula after pancreaticoduodenectomy （PD） and to analyze the risk factors of postoperative pancreatic fistula. Method 81 patients taking PD at our hospital from July, 2014 to July, 2017 were selected as study objects. No pancreatic fistula occurred 5 d after the operation. According to the times of the abdominal drainage tube removal after PD, they were divided into two groups. The abdominal drainage tubes of group A （34 cases ） were removed within 5 d after the surgery, while those of group B （47 cases ） more than 5 d after the surgery. The postoperative complications were compared between the two groups. In addition, according to whether having pancreatic fistula or not, they were divided into a pancreatic fistula group and a non-pancreatic fistula group. The risk factors associated with postoperative pancreatic fistula were analyzed by single factor and multivariate Logistic regression. Results The incidences of postoperative pancreatic fistula and abdominal infection was significantly lower in group A than in the control group （11.76% vs. 34.04% and 5.88% vs. 23.40%, P〈0.05 ） . single factor analysis showed that the related factors influencing occurrence of pancreatic fistula after PD were age, pancreas texture, the main pancreatic duct diameter, operation time, intraoperative bleeding volume, the removal time of postoperative abdominal drainage tube, and tumor location. Multivariate Logistic regression analysis showed that the independent risk factors for pancreatic fistula after PD were advanced age, soft pancreatic quality, operation time, and the removal time of peritoneal drainage tube. Conclusions That removes the abdominal drainage tubes of patients with early non-pancreatic fistula within 5 d after PD can effectively reduce the occurrence of pancreatic fistula, abdominal cavity infection, and so on. However, prolonged catheterization increases the risk of postoperative pancreatic fistula.

关 键 词：胰十二指肠切除术 腹腔引流 胰瘘 腹腔感染 

分 类 号：R735[医药卫生—肿瘤]