预后营养指数对远端胰腺切除术后临床相关胰瘘的影响及其相关因素分析  

Effect of prognostic nutritional index on clinically related postoperative pancreatic fistula after distal pancreatectomy and their related influencing factors

作　　者：李浩 王飞通 王聪 魏鑫 刘斌 LI Hao;WANG Feitong;WANG Cong;WEI Xin;LIU Bin(Xuzhou Medical University,Xuzhou,Jiangsu 221004,P.R.China;Department of General Surgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221004,P.R.China)

机构地区：[1]徐州医科大学,江苏徐州221004 [2]徐州医科大学附属医院普外科,江苏徐州221004

出　　处：《中国普外基础与临床杂志》2022年第2期211-217,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨术前预后营养指数(prognostic nutritional index,PNI)对远端胰腺切除术(distal pancreatectomy,DP)后患者临床相关胰瘘(clinically related postoperative pancreatic fistula,CR-POPF)发生的影响及CR-POPF发生的影响因素,为临床预测CR-POPF提供依据。方法回顾性收集2017年1月1日至2021年1月31日期间在徐州医科大学附属医院顺利完成DP且符合本研究纳入和排除标准患者的临床病理资料。计算患者术前PNI值并根据受试者操作特征曲线(ROC)获得最佳截取值,以最佳截取值为界分为低和高PNI,比较低和高PNI以及是否发生CR-POPF患者间的临床病理特征,同时采用多因素logistic回归分析患者CR-POPF发生的影响因素。结果本研究共纳入符合纳入和排除标准患者143例,术后发生CR-POPF 33例(23.08%),术前PNI平均值为52.26(39.20~65.10)。根据术前PNI预测CR-POPF的发生情况绘制ROC曲线得到PNI的最佳截取值为50.55,低PNI(<50.55)49例、高PNI(≥50.55)94例。年龄≥65岁者和发生CR-POPF者在低PNI患者中占比高于高PNI患者(P<0.05);胰腺质地较软者和低PNI者在术后发生CR-POPF患者中占比较术后未发生CR-POPF者高(P<0.05)。进一步将术前PNI和胰腺质地结合其他研究认为与CR-POPF发生相关的因素(手术方式、术中出血量、脾脏处理)带入二分类logistic回归进行多因素分析,结果发现,术前低PNI(OR=5.417,P<0.001)和较软的胰腺质地(OR=4.126,P=0.002)增加CR-POPF发生的风险。结论术前低PNI和胰腺质地软增加DP后CR-POPF发生的风险,术前有必要对患者PNI状况进行评估。Objective To explore effect of preoperative prognostic nutritional index(PNI)on clinically related postoperative pancreatic fistula(CR-POPF)after distal pancreatectomy(DP)and analyze its influencing factors in order to provide a basis for clinical prediction of CR-POPF.Methods The clinicopathologic data of patients who successfully completed DP in the Affiliated Hospital of Xuzhou Medical University and met the inclusion and exclusion criteria of this study from January 1,2017 to January 31,2021 were collected retrospectively.The preoperative PNI value was calculated and the optimal cut-off value was obtained according to the receiver operative characteristic(ROC)curve.The patients were divided into low and high PNI based on the optimal cut-off value.The clinicopathologic characteristics were compared between the patients with low and high PNI and CR-POPF or not.At the same time,multivariate logistic regression was used to analyze the influencing factors of CR-POPF.Results A total of 143 patients who met the inclusion and exclusion criteria were included in this study.The CR-POPF occurred in 33 cases(23.08%)after DP,and the average preoperative PNI was 52.26(39.20–65.10),the optimal cut-off value of PNI was 50.55,with 49 cases in the low PNI group and 94 cases in the high PNI group.In patient with low PNI,the proportions of patients aged≥65 years and with CR-POPF were higher than those with high PNI(P<0.05).In the patients with CR-POPF,the proportions of patients with soft pancreatic texture and with low preoperative PIN were higher than those without CR-POPF(P<0.05).Further,the multivariate logistic regression showed that the the preoperative low PNI(OR=5.417,P<0.001)and soft pancreatic texture(OR=4.126,P=0.002)increased the risk of CR-POPF.Conclusion Low preoperative PNI and soft pancreatic texture increase risk of CR-POPF after DP,and it is necessary to preoperatively evaluate PNI status of patients.

关 键 词：临床相关胰瘘 远端胰腺切除术 预后营养指数 影响因素 

分 类 号：R657.5[医药卫生—外科学]