胰腺残端胰腺腺泡细胞数量在PD术后胰瘘的应用价值研究  

The value of pancreatic acinar cell number in pancreatic stump after pancreatic fistula after PD

作　　者：陈兵[1] CHEN Bing(Department of Gastrointestinal Oncology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院胃肠肿瘤外科,乌鲁木齐830054

出　　处：《肝胆外科杂志》2019年第5期344-348,共5页Journal of Hepatobiliary Surgery

摘　　要：目的评估术后胰瘘与胰腺残端腺泡细胞数量的相关性,并评估其是否可以作为胰瘘的危险因素.方法回顾性分析2015年4月~2018年4月期间我院69例行PD手术的患者.根据术后有无发生胰瘘分为胰瘘组和非胰瘘组,对比分析两组患者的临床数据以及实验室参数,运用Spearman相关性检验分析胰腺残端腺泡细胞数量和引流液淀粉酶含量之间的相关性,使用logistical回归分析确定术后胰瘘的独立危险因素,单变量分析中P<0.05的变量纳入到多变量分析中.结果最终胰瘘组20例,无胰瘘组49例.胰瘘组的软胰腺的比例较非胰瘘组显著升高(45.0%和10.2%,P<0.001),并且术后第3天引流液中淀粉酶含量和住院时间均显著高于非胰瘘组(P<0.001).此外,胰瘘组的胰腺残端腺泡细胞计数显著高于非胰瘘组(898.9±161.8和443.1±127.6,P<0.001).胰腺残端胰腺腺泡细胞的数量与引流液中淀粉酶含量呈正相关性(r=0.991,P<0.001).多因素分析结果显示显示胰腺质地软(OR:5.060,95%C1:1.252~7.798,P<0.001),较高的胰腺残端胰腺腺泡细胞计数(OR:2.662,95%C1:1.132~3.947,P<0.001)是PD后发生胰瘘的独立危险因素.结论胰腺质地和胰腺残端的腺泡细胞计数是PD术后出现胰瘘的独立危险因素.Objective To evaluate the correlation between postoperative pancreatic fistula and the number of acinar cells in the pancreatic stump,and to evaluate whether it can he used as a risk factor for pancreatic fistula.Methods Retrospective analysis of 69 patients undergoing PD surgery during April 2015 to April 2018 in our hospital.According to the occurrence of pancreatic fistula after surgery,it was divided into pancreatic fistula group and non-pancreatic fistula group.The clinical data and laboratory parameters of the two groups of patients were compared and analyzed.The Spearman correlation test was used to analyze the correlation between the number of acinar cells in the pancreatic stump and the amylase content in the drainage fluid.Logistic regression analysis was used to determine the independent risk factors for postoperative pancreatic fistula.Variables with P<0.05 in univariate analysis were included in the multivariate analysis.Results Finally 20 patients in the pancreatic fistula(POPF)group and 49 in the no pancreatic fistula(no-POPF)group.The proportion of soft pancreas in the POPF group was significantly higher than that in the no-POPF group(45.0% vs 10.2%,P<0.001).At the third day postoperatively,the amylase content and length of hospital stay in POPF group were significantly higher than those in no-POPF group(P<0.001).In addition,the number of acinar cells in the pancreatic stump of the POPF group was significantly higher than that of the no-POPF group(898.9±161.8 vs 443.1±127.6,P<0.001).The number of pancreatic acinar cells in the pancreatic stump was positively correlated with the amylase content in the drainage fluid(r=0.991,P<0.001).Multivariate analysis showed that the pancreas was soft(OR:5.060,95% C1:1.252〜7.798,P<0.001)and higher pancreatic acinar cell counts(OR:2.662,95% C1:1.132〜3.947).(P<0.001)is an independent risk factor for pancreatic fistula after PD.Conciusion The acinar cell count of the pancreas and pancreatic stump is an independent risk factor for pancreatic fistula after PD.

关 键 词：胰十二指肠切除术 胰瘘 软胰腺 胰腺腺泡细胞计数 危险因素 

分 类 号：R735.9[医药卫生—肿瘤]