胰体尾切除术后胰瘘影响因素的多因素分析  

Multivariate analysis of influencing factor of pancreatic fistula after distal pancreatectomy

作　　者：孔祥虎 韩玮[1] 李秋影 KONG Xianghu;HAN Wei;LI Qiuying(Department of Pancreas Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,P.R.China;Department of Geriatrics,The Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,P.R.China)

机构地区：[1]新疆医科大学第一附属医院胰腺外科,乌鲁木齐830000 [2]新疆医科大学第五附属医院老年病科,乌鲁木齐830000

出　　处：《中国普外基础与临床杂志》2020年第6期708-713,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨胰体尾切除术(DP)后影响术后胰瘘(POPF)发生的因素。方法回顾性分析2014年1月至2019年6月期间于新疆医科大学第一附属医院实施DP的114例患者的临床资料。结果本组114例患者DP后发生POPF 43例(37.7%),其中A级(生化瘘)19例,B级21例,C级3例。单因素分析结果显示:POPF组和无POPF组的BMI值、饮酒史、术前血浆白蛋白水平、术后血浆白蛋白水平、术后中性粒细胞/淋巴细胞比值(NLR)、术前预后营养指数(PNI)值和术后PNI值比较差异均有统计学意义(P<0.05)。多因素分析结果表明:术前血浆白蛋白>35 g/L[OR=0.115,95%CI为(0.038,0.348)]、术后血浆白蛋白>35 g/L[OR=0.126,95%CI为(0.031,0.516)]和术后NLR值≤6.65[OR=0.149,95%CI为(0.048,0.461)]均是DP后POPF发生的影响因素。术后NLR值预测DP后POPF发生的效能较高,曲线下面积为0.731[95%CI为(0.639,0.824)]。结论手术前后的血浆白蛋白>35 g/L和术后NLR值≤6.65是DP后POPF的保护因素,且术后外周血NLR值可作为DP后POPF的预测指标。Objective To investigate the factors that affect the occurrence of postoperative pancreatic fistula(POPF)after distal pancreatectomy(DP).Methods The clinical data of 114 patients underwent DP who were performed in the First Affiliated Hospital of Xinjiang Medical University from Jan.2014 to Jun.2019,were retrospectively analyzed.Results In this group of 114 patients,43 cases(37.7%)of POPF occurred after DP,including 19 cases of grade A(biochemical fistula),21 cases of grade B,and 3 cases of grade C.The univariate analysis results showed that:BMI value,drinking history,preoperative plasma albumin level,postoperative plasma albumin level,postoperative neutrophil/lymphocyte ratio(NLR),preoperative and postoperative prognostic nutrition index(PNI)levels were significant different between the POPF group and non-POPF group(P<0.05).Multivariate analysis results showed that:preoperative plasma albumin>35 g/L[OR=0.115,95%CI was(0.038,0.348)],postoperative plasma albumin>35 g/L[OR=0.126,95%CI was(0.031,0.516)],and postoperative NLR value≤6.65[OR=0.149,95%CI was(0.048,0.461)]were the influencing factors of POPF after DP.The area under curve of postoperative NLR was 0.731[95%CI was(0.639,0.824)].Conclusion Preoperative and postoperative plasma albumin>35 g/L,as well as postoperative NLR≤6.65 are protective factors for POPF after DP,and postoperative NLR can be used as a predictor of POPF.

关 键 词：胰体尾切除术 术后胰瘘 中性粒细胞/淋巴细胞比值 预后营养指数 

分 类 号：R657.5[医药卫生—外科学]