胰十二指肠切除术后急性胰腺炎的诊治及危险因素分析  

The diagnosis and risk factors for postoperative acute pancreatitis following pancreaticoduodenectomy

作　　者：王道斌 孙鼎[1] 张伟刚[1] 唐祖雄[1] 仇俊毅 秦磊[1] 钱海鑫[1] 薛小峰[1] Wang Daobin;Sun Ding;Zhang Weigang;Tang Zuxiong;Qiu Junyi;Qin Lei;Qian Haixin;Xue Xiaofeng(Department of General Surgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院肝胆胰外科,苏州215006

出　　处：《中华普通外科杂志》2022年第7期487-491,共5页Chinese Journal of General Surgery

摘　　要：目的探讨胰十二指肠切除术后急性胰腺炎(POAP)发生的相关危险因素。方法回顾性分析2020年1月至2021年8月苏州大学附属第一医院60例胰十二指肠切除术患者的临床资料。术后4~9 d复查上腹部增强CT评价是否合并POAP。结果60例患者中,合并POAP者13例(21.7%)。POAP组患者中胰瘘合并感染(76.9%比19.1%,χ^(2)=15.71,P<0.0001),术后住院天数(26 d比18 d,U=141.5,P=0.0025),并发症严重程度(Clavien-Dindo分级≥Ⅲ级:53.8%比21.3%,χ^(2)=5.32,P=0.02)显著高于非POAP组;两组中重度迟发性出血(7.7%比0,χ^(2)=3.68,P=0.06),胃排空障碍(30.8%比21.3%,χ^(2)=0.51,P=0.47)差异无统计学意义。单因素分析发现,当患者具有高BMI指数(P=0.0003),胰管直径细(P<0.0001),胰腺质地软(P=0.009)时,胰十二指肠切除术术后更易合并POAP;Logistic多因素回归分析发现主胰管直径≤2 mm(OR=0.005,95%CI:0.00006~0.44,P=0.020)、胰腺质地软(OR=0.005,95%CI:0.00004~0.47,P=0.023)为胰十二指肠切除术后POAP发生的独立危险因素。结论胰十二指肠切除术后POAP显著增加了胰瘘合并感染发生率,胰管直径细、胰腺质地软是胰十二指肠切除术后POAP的独立危险因素。Objective To study factors associated with postoperative acute pancreatitis(POAP)in patients following pancreaticoduodenectomy.Methods This retrospective analysis included 60 patients who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Soochow University from Jan 2020 to Aug 2021.Enhanced computed tomography was used to identify POAP during postoperative period of 4 to 9 days.Univariate analysis and multivariate analysis were used to find out the risk factors of POAP.Results Of the 60 patients,13 cases(21.7%)developed POAP.The incidence of clinically related pancreatic fistula with abdominal abscess(76.9%vs.19.1%,χ^(2)=15.71,P<0.0001),postoperative hospital stay(26 d vs.18 d,U=141.5,P=0.0025)and the severity of complications(Clavien-Dindo grade≥Ⅲ:53.8%vs.21.3%,χ^(2)=5.32,P=0.02)were significantly higher in the POAP group.But there was no significant deviation between the two groups when it comes to the severe post pancreatectomy delayed hemorrhage(7.7%vs.0,χ^(2)=3.68,P=0.06)and the delayed gastric emptying(30.8%vs.21.3%,χ^(2)=0.51,P=0.47).In the univariate analysis,patients with higher body mass index(P=0.0003),smaller main pancreatic duct diameter(P<0.0001)and softer texture of the pancreas(P=0.009)were more likely to develop POAP after pancreaticoduodenectomy.In the multivariate analysis,the pancreatic duct diameter≤2 mm(OR=0.005,95%CI 0.00006-0.44,P=0.020),the softer texture of pancreas(OR=0.005,95%CI 0.00004-0.47,P=0.023)were risk factors for POAP.Conclusions Patients with postoperative acute pancreatitis increased the incidence of pancreatic fistula complicating abdominal abscess.Small caliber pancreatic tube,soft texture of pancreas were risk factors of POAP.

关 键 词：胰十二指肠切除术 胰腺炎 诊断 危险因素 

分 类 号：R657.51[医药卫生—外科学]