实时弹性成像对胰十二指肠切除术后胰瘘的预测价值  

Value of real-time elastography in predicting the risk of pancreatic fistula after pancreaticoduodenectomy

作　　者：吴燕彬 朱花敏 王学文 牛洪凯 成雨[1] WU Yanbin;ZHU Huamin;WANG Xuewen(Department of Hepatobiliary Surgery,The Affiliated Hospital of Binzhou Medical University,Binzhou,Shandong 256600,China)

机构地区：[1]山东省滨州医学院附属医院肝胆外科

出　　处：《临床肝胆病杂志》2019年第7期1541-1545,共5页Journal of Clinical Hepatology

基　　金：山东省普外科临床重点专科建设基金资助项目(ZDZK2013SJ09)

摘　　要：目的探讨实时弹性成像(SWE)技术检测胰腺组织弹性来预测胰瘘的风险,通过检测胰体部的SWE水平来衡量胰腺硬度,以减少胰十二指肠切除术后胰瘘的发生。方法回顾性分析2017年10月-2019年2月山东省滨州医学院附属医院收治的53例胰十二指肠切除术(PD)患者的临床资料。53例中10例PD术后发生胰瘘(胰瘘组),43例未发生(非胰瘘组)。应用超声中的SWE技术检测胰体部位的弹性值,反应胰腺的组织弹性,评估胰腺的硬度。计量资料两组间比较采用t检验,计数资料组间比较采用χ^2检验。单因素分析采用logistic回归分析,Spearman相关系数被用来检验SWE和其他实验室数据的相关性。结果 BMI(t=1. 321)、术前总胆红素(t=1. 347)、主胰管直径(t=1. 385)、SWE最大值(t=1. 728)、SWE平均值(t=1. 634)、术中胰腺软硬(χ^2=4. 983)是胰瘘的风险因素(P值均<0. 05)。SWE最大值和SWE平均值与年龄、手术时间均呈负相关(最大值:r值分别为-0. 329、-0. 260,P值均<0. 05;平均值:r值分别为-0. 282、-0. 282,P值均<0. 05),与BMI均呈正相关(r值分别为0. 275、0. 350,P值均<0. 05)。结论 SWE水平是PD后胰瘘的独立危险因素,胰体部SWE水平对PD术后胰瘘具有高度预测价值,对患者行手术治疗具有指导意义。Objective Objective To investigate the value of pancreatic elasticity based on shear wave elastography (SWE) in predicting the risk of pancreatic fistula, to measure pancreatic hardness by determining the SWE level of the pancreatic body, and to reduce the development of pancreatic fistula after pancreaticoduodenectomy. Methods A retrospective analysis was performed for the clinical data of 53 patients who were admitted to The Affiliated Hospital of Binzhou Medical University from October 2017 to February 2019 and underwent pancreaticoduodenectomy (PD). The 53 patients were divided into pancreatic fistula group with 10 patients who developed pancreatic fistula after PD and non-pancreatic fistula group with 43 patients who did not develop this disease after PD. The elasticity value of the pancreatic body measured by SWE was used to reflect the tissue elasticity of the pancreas and evaluate the hardness of the pancreas. The t -test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used for univariate analysis, and the Spearman’s correlation coefficient was used to investigate the correlation between SWE and other laboratory data. Results Body mass index (BMI)(t =1.321), preoperative total bilirubin ( t =1.347), diameter of the main pancreatic duct ( t =1.385), maximum SWE value ( t =1.728), mean SWE value ( t =1.634), and intraoperative pancreatic hardness (χ^2 =4.983) were risk factors for pancreatic fistula (all P <0.05). Maximum SWE value and mean SWE value were negatively correlated with age and time of operation (maximum SWE value: r =-0.329 and -0.260, both P <0.05;mean SWE value: r =-0.282, and -0.282, both P <0.05) and positively correlated with BMI ( r =0.275 and 0.350, both P <0.05). Conclusion SWE level is an independent risk factor for pancreatic fistula after pancreaticoduodenectomy, and the SWE level of the pancreatic body has a high predictive value and guiding signif

关 键 词：胰十二指肠切除术 胰腺瘘 弹性成像技术 危险因素 

分 类 号：R657.5[医药卫生—外科学]