胰十二指肠切除术后腹腔引流液淀粉酶水平对B、C级胰瘘预测作用的探讨  

Amylase value in drains after pancreaticoduodenectomy as predictive factor of grade B and C postoperative pancreatic fistula

作　　者：马春龙 韩玮[2] MA Chunlong;HAN Wei(Xinjiang Medical University,Urumqi 830000,P. R. China;The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,P. R. China)

机构地区：[1]新疆医科大学,乌鲁木齐830000 [2]新疆医科大学第一附属医院,乌鲁木齐830000

出　　处：《中国普外基础与临床杂志》2019年第8期939-942,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨胰十二指肠切除术(PD)后腹腔引流液淀粉酶对胰瘘发生的预测价值。方法回顾性分析新疆医科大学第一附属医院2014年6月至2018年6月期间实施的106例PD患者的临床资料。结果本组106例PD患者中发生胰瘘24例(22.6%),其中A级18例、B级4例、C级2例。单因素分析发现,PD患者的年龄、肿瘤直径、胰腺质地及主胰管直径与PD后发生胰瘘有关(P<0.050),多因素logistic回归分析发现主胰管直径≤3mm是PD后胰瘘发生的独立危险因素(OR=4.856,P=0.004)。PD后第5、7、10天时腹腔引流液淀粉酶水平对胰瘘(A+B+C级)的诊断效能较好,其受试者操作特征曲线下面积(AUC)值分别为0.910、0.951、0.948;术后第10天时腹腔引流液淀粉酶水平对B+C级胰瘘的诊断效能较好,其AUC值为0.938。结论PD后第5、7、10天时腹腔引流液淀粉酶水平对胰瘘的诊断效能较好,尤其是术后第10天时腹腔引流液淀粉酶水平对B+C级胰瘘的诊断效能较佳。Objective To investigate predictive value of amylase level in intraperitoneal drainage fluid after pancreaticoduodenectomy (PD) for grade B and C pancreatic fistula (PF). Method The clinical data of 106 patients underwent PD in the First Affiliated Hospital of Xinjiang Medical University from June 2014 to June 2018 were retrospectively analyzed. Results Twenty-four cases (22.6%) had the PF after the PD, in which of 18 cases of grade A, 4 cases of grade B, and 2 cases of grade C. The age, tumor diameter, pancreatic texture, and main pancreatic duct diameter were associated with the PF after the PD by the univariate analysis (P<0.050), the main pancreatic duct diameter (OR=4.856, P=0.004) was its independent risk factor. The amylase levels of intraperitoneal drainage fluid on day 5, 7, and 10 after the PD could better predict the occurrence of PF (AUC was 0.910, 0.951, 0.948, respectively), especially which on day 10 after the PD could better predict the occurrence of grade B and C PF (AUC was 0.938). Conclusion Elevated amylase levels in peritoneal drainage fluid on day 5, 7, and 10 after PD have better diagnostic effects on PF, especially which on day 10 after PD has a better diagnostic effect on grade B and C PF.

关 键 词：胰十二指肠切除术 腹腔引流液 淀粉酶 胰瘘 

分 类 号：R657.5[医药卫生—外科学]