胰十二指肠切除术后发生胃排空延迟的危险因素分析及预测列线图的建立  

Risk factors of delayed gastric emptying after pancreaticoduodenectomy and establishment of predictive nomogram

作　　者：王亚栋 刘凤悦[1] 马德林 朱民[1] WANG Ya-dong;LIU Feng-yue;MA De-lin;ZHU Min(Department of Organ Transplantation,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院器官移植科,山东济南250012

出　　处：《中国现代普通外科进展》2023年第1期33-37,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探索胰十二指肠切除术后发生胃排空延迟(DGE)的危险因素并构建预测模型。方法:回顾性收集山东大学齐鲁医院器官移植科收治的104例行胰十二指肠切除术的患者,根据是否发生DGE分为病例组及正常组,经单因素及多因素分析后,筛选影响DGE的独立影响因素,并构建预测模型。结果:多因素Logistic回归分析结果显示胃肠吻合方式(OR=0.061,95%CI:0.006~0.647)、术前行PTCD(OR=6.837,95%CI:1.527~30.612),术前直接胆红素(OR=8.784,95%CI:1.562~49.385),术后输血(OR=10.238,95%CI:2.134~49.114)以及二次手术(OR=37.172,95%CI:1.224~1129.347)为影响术后DGE的独立影响因素(P<0.05)。以这5个变量构建了预测DGE的列线图模型,曲线下面积为0.877(95%CI:0.803~0.951),Calibration校准曲线显示模型预测的风险与实际风险之间具有较好的一致性。结论:使用线形胃肠吻合能够降低DGE的发生率,而术前行PTCD、术前直接胆红素>100μmol/L、术后输血及二次手术均会增加DGE的发生率。利用这些变量构建的预后模型能够很好地预测术后DGE的发生,能够帮助临床医师早期识别和干预。Objective: To explore the risk factors of delayed gastric emptying(DGE) after pancreaticoduodenectomy and to construct a prediction model. Methods: A total of 104 patients who underwent pancreaticoduodenectomy in the Department of Organ Transplantation, Qilu Hospital,Shandong University were retrospectively collected and divided into normal group and disease group according to the occurrence of DGE. After univariate and multivariate analysis, independent risk factors of DGE were screened and a prediction model was constructed. Results: Multivariate Logistic regression analysis showed that gastrointestinal anastomosis type(OR=0.061, 95% CI:0.006-0.647), PTCD(OR=6.837, 95% CI: 1.527 ~30.612), Direct bilirubin(OR=8.784, 95% CI:1.562~49.385), Postoperative blood transfusion(OR=10.238, 95% CI: 2.134~49.114) and re-operation(OR=37.172, 95% CI: 1.224~1129.347) were the independent risk factors of DGE. Subsequently, the nomogram for predicting DGE was constructed using these five variables. The AUC of the ROC curve of the model was 0.877(95% CI: 0.803~0.951). The Calibration curve showed that the risk predicted by the model was in good agreement with the actual risk. Conclusion: using the linear gastrointestinal anastomosis can reduce the incidence rate of DGE, and preoperative PTCD,preoperative direct bilirubin > 100μmol/L, postoperative blood transfusion and re-operation will increase the incidence rate of DGE. The prognostic model constructed by using these variables can well predict the occurrence of DGE and help clinicians to identify and intervene this disease early.

关 键 词：胃排空延迟 胰十二指肠切除术 LOGISTIC回归 列线图 

分 类 号：R619[医药卫生—外科学]