血栓弹力图测定对远端胆管癌胰十二指肠切除术后出血的预测价值  

Predictive value of thromboelastography in bleeding after pancreaticoduodenectomy in patients with distal cholangiocarcinoma

作　　者：李杰[1] 任加强 马坚 王铮[1] 马清涌[1] 仵正[1] Li Jie;Ren Jiaqiang;Ma Jian;Wang Zheng;Ma Qingyong;Wu Zheng(Department of Hepatobiliary Surgery,the First Afiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华肝脏外科手术学电子杂志》2023年第2期211-215,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：基金资助:陕西省创新能力支撑计划(2022PT-35);陕西省自然科学基础研究计划(2020JQ-510);西安交通大学第一附属医院科研发展基金(2021QN-24)。

摘　　要：目的探讨远端胆管癌胰十二指肠切除术(PD)术后出血患者的临床特点及血栓弹力图(TEG)对术后出血的预测价值。方法回顾性分析2016年1月至2018年8月在西安交通大学第一附属医院行PD的162例远端胆管癌患者临床资料。其中男100例,女62例;年龄39~78岁,中位年龄64岁。患者均签署知情同意书,符合医学伦理学规定。根据患者是否发生术后出血分为出血组(29例)和未出血组(133例)。两组围手术期情况比较采用秩和检验或χ2检验。将患者肿瘤标志物、凝血功能和TEG相关指标纳入术后出血影响因素分析,采用单因素和多因素Logistic回归分析术后出血的独立影响因素;建立Logistic回归模型,采用ROC曲线判断该模型的预测价值。结果出血组患者术后发生胰瘘、胃排空障碍、90 d死亡分别为19、25、5例,未出血组分别为79、57、3例,差异有统计学意义(χ2=32.874,17.899,11.390;P<0.05)。出血组ICU时间、术后住院时间中位数分别为2(0,4)、22(17,34)d,明显长于未出血组的1(0,2)、16(14,19)d(Z=2.014,4.005;P<0.05)。多因素Logistic回归分析显示,TEG测定凝血形成时间K和Plt是远端胆管癌患者PD术后出血的独立影响因素(OR=0.193,0.298;P<0.05),以两者建立的模型预测术后出血的ROC曲线下面积为0.742(95%CI:0.637~0.847)。结论远端胆管癌PD术后出血患者容易出现胰瘘、胃排空障碍、早期死亡,基于术前TEG测定及Plt构建模型对术后出血有一定的预测价值。Objective To investigate the clinical features of patients with distal cholangiocarcinoma who developed bleeding after pancreaticoduodenectomy(PD)and assess the predictive value of thromboelastography(TEG)in postoperative bleeding.Methods Clinical data of 162 patients with distal cholangiocarcinoma who underwent PD in the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to August 2018 were retrospectively analyzed.Among them,100 patients were male and 62 female,aged from 39 to 78 years,with a median age of 64 years.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the bleeding group(n=29)and non-bleeding group(n=133)according to whether postoperative bleeding occurred.Perioperative conditions between two groups were compared by rank-sum test or Chi-square test.Patients'tumor markers,coagulation function and TEG-related indexes were included in the analysis of influencing factors of postoperative bleeding.The independent influencing factors of postoperative bleeding were identified by univariate and multivariate Logistic regression analyses.Logistic regression model was established,and predictive value of this model was evaluated by ROC curve.Results Pancreatic fistula,gastric emptying disturbance and 90-d mortality occurred in 19,25 and 5 cases in the bleeding group,whereas 79,57 and 3 cases in the non-bleeding group,significant differences were observed between two groups(χ2=32.874,17.899,11.390;P<0.05).In the bleeding group,the median length of ICU stay and length of postoperative hospital stay were 2(0,4)d and 22(17,34)d,significantly longer than 1(0,2)d and 16(14,19)din the non-bleeding group(Z=2.014,4.005;P<0.05).Multivariate Logistic regression analysis showed that coagulation time K and Plt measured by TEG were the independent influencing factors of bleeding after PD in patients with distal cholangiocarcinoma(OR=0.193,0.298;P<0.05).The area under the ROC curve of the model based on these two fact

关 键 词：胆管肿瘤 胰十二指肠切除术 出血 血栓弹力图 

分 类 号：R735.8[医药卫生—肿瘤]