腹腔镜胰十二指肠切除术后胰瘘的危险因素分析  

Analysis of pancreatic leakage after laparoscopic pancreatoduodenectomy and its risk factors

作　　者：尹立阳 郭书华 石媛媛[1] 袁增江[1] YIN Li-yang;GUO Shu-hua;SHI Yuan-yuan;YUAN Zeng-jiang(Three Branches of General Surgery,Handan Central Hospital,Hebei Province,Handan 056001,China)

机构地区：[1]邯郸市中心医院普外三科,河北邯郸056001

出　　处：《中国现代普通外科进展》2020年第8期610-613,共4页Chinese Journal of Current Advances in General Surgery

基　　金：2019年度河北省医学科学研究课题计划(20190199)。

摘　　要：目的:探讨腹腔镜胰十二指肠切除术(LPD)后发生胰瘘的危险因素。方法:选择我院2016年6月-2018年9月行LPD治疗的124例患者作为研究对象,根据术后是否出现胰瘘分为胰瘘组(37例)和无胰瘘组(87例)。采用调查问卷及查阅临床资料相结合的方式,分析不同特征患者术后胰瘘发生情况,通过多因素Logistic回归分析影响术后胰瘘发生的危险因素。结果:124例患者均顺利完成LPD,术后共37例(29.8%)患者出现胰瘘,其中化学漏20例,B级胰瘘14例,C级胰瘘3例。单因素分析显示年龄、胰腺质地、主胰管直径、术中失血量、肿瘤发生部位、术前总胆红素、术前白蛋白水平与术后胰瘘有关;多因素Logistic回归分析显示年龄(OR=5.028)、胰腺质地(OR=13.543)、主胰管直径(OR=2.502)、术前总胆红素(9.137)及术前白蛋白水平(OR=6.050)为术后胰瘘发生的独立危险因素。结论:LPD术后发生胰瘘的危险因素较多,手术前后加强管理,减少术后胰瘘发生概率。Objective:To explore pancreatic leakage after laparoscopic pancreatoduodenec-tomy(LPD)and its risk factors.Methods:124 patients treated with LPD in our hospital from June 2016 to September 2018 were selected as research objects.According to whether pancreatic fistula occurred after operation,they were divided into the pancreatic fistula group(37 cases)and the non-pancreatic fistula group(87 cases).Combined with questionnaires and clinical data,the incidence of postoperative pancreatic leakage in different characteristics was analyzed,and the related risk factors affecting postoperative pancreatic leakage were analyzed by multivariate logistic regression.Results:All 124 patients successfully completed LPD,and a total of 37 patients developed pancreatic fistula(29.8%),14 patients with grade B pancreatic leakage(11.3%),and 3 patients with grade C pancreatic fistula(2.4%);Single-factor analysis preliminarily screened out 7 risk factors related to postoperative pancreatic leakage[age,pancreatic texture,main pancreatic duct diameter,intraoperative blood loss,tumor site,preoperative total bilirubin,preoperative albumin level];Multivariate Logistic regression analysis showed that age(OR=5.028),pancreatic quality(OR=13.543),main pancreatic duct diameter(OR=2.502),preoperative total bilirubin(9.137)and preoperative albumin level(OR=6.050)were independent risk factors for postoperative pancreatic leakage.Conclusion:There are many risk factors for pancreatic leakage after LPD,especially for patients with soft pancreas,somatostatin should be applied prophylactly to reduce the risk of postoperative pancreatic leakage.

关 键 词：胰十二指肠切除术 腹腔镜 胰瘘 危险因素 

分 类 号：R657.5[医药卫生—外科学]