术前胆道引流对胰十二指肠切除术后手术相关并发症发生的影响因素分析  

Influencing of preoperative biliary drainage on surgery-related complications after pancreaticoduodenectomy

作　　者：林华骏 冯哲文 辛城霖 管成剑 张小东 闵逸洋 顾晓哲 郭伟[1] 汪栋[1] Lin Huajun;Feng Zhewen;Xin Chenglin;Guan Chengjian;Zhang Xiaodong;Min Yiyang;Gu Xiaozhe;Guo Wei;Wang Dong(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Sub Center of National Clinical Research Center for Digestive Diseases,Beijing 100050,China;Department of General Surgery,the First Affiliated Hospital of Ningbo University,Ningbo 315020,Zhejiang Province,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,国家消化疾病中心普外分中心,北京100050 [2]宁波大学附属第一医院普通外科,宁波315020

出　　处：《中华消化外科杂志》2023年第7期909-915,共7页Chinese Journal of Digestive Surgery

基　　金：北京市医院管理中心临床医学发展专项(XMLX202102)。

摘　　要：目的探讨术前胆道引流对胰十二指肠切除术后手术相关并发症发生的影响因素。方法采用回顾性病例对照研究方法。收集2016年1月至2020年7月首都医科大学附属北京友谊医院收治的267例壶腹周围占位性病变患者的临床资料;男166例,女101例;年龄为61(54~84)岁。观察指标:(1)术前行和未行胆道引流患者术前情况比较。(2)术前行和未行胆道引流患者术中和术后情况比较。(3)术前胆道引流方式及疗效。(4)影响胰十二指肠切除术后手术相关并发症发生的因素分析。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)或M(Q1,Q3)表示,组间比较采用Mann⁃Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ²检验。单因素分析根据资料类型选择对应的统计学方法。多因素分析采用Logistic逐步回归模型。结果(1)术前行和未行胆道引流患者术前情况比较。267例患者中,术前行胆道引流104例,术前未行胆道引流163例。术前行和未行胆道引流患者病理学类型恶性肿瘤、交界性肿瘤、慢性胰腺炎分别为89、13、2例和111、41、11例,两者病理学类型比较,差异有统计学意义(χ²=10.652,P<0.05)。(2)术前行和未行胆道引流患者术中和术后情况比较。104例术前行胆道引流患者和163例术前未行胆道引流患者手术时间,术中出血量,术后并发症、B级和C级胰漏、胆漏、腹腔或消化道出血、腹腔感染发生率,术后第1天白细胞计数、术后第3天白细胞计数、术后第1天中性粒细胞淋巴细胞百分比、术后第3天中性粒细胞淋巴细胞百分比、术后第1天C反应蛋白白蛋白比值、术后第3天C反应蛋白白蛋白比值,住院时间比较,差异均无统计学意义(P>0.05)。(3)术前胆道引流方式及疗效。104例术前行胆道引流患者中,内镜下鼻胆管引流40例,引流时间为(12±2)d;经皮经肝胆管引流38�Objective To investigate the influencing of preoperative biliary drainage on surgery-related complications after pancreaticoduodenectomy.Methods The retrospective casecontrol study was conducted.The clinical data of 267 patients with periampullary space-occupying lesion who were admitted to Beijing Friendship Hospital of Capital Medical University from January 2016 to July 2020 were collected.There were 166 males and 101 females,aged 61(range,54‒84)years.Observation indicators:(1)comparison of preoperative situations in patients with and without preoperative biliary drainage;(2)comparison of intraoperative and postoperative situations in patients with and without preoperative biliary drainage;(3)methods and efficacy of preoperative biliary drainage;(4)factors influencing surgery-related complications after pancreaticoduodenectomy.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(rang)or M(Q1,Q3),and comparison between groups was conducted using the Mann-Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test.Univariate analysis was conducted using the corresponding statistical methods based on data type.Multivariate analysis was conducted using the Logistic stepwise regression model.Results(1)Comparison of preoperative situations in patients with and without preoperative biliary drainage.Of the 267 patients,there were 104 cases with preoperative biliary drainage and 163 cases without preoperative biliary drainage.Cases with malignant tumor,cases with borderline tumor,cases with chronic pancreatitis were 89,13,2 in patients with preoperative biliary drainage,versus 111,41,11 in patients without preoperative biliary drainage,showing significant differences in pathology type between them(χ2=10.652,P<0.05).(2)Comparison of intraoperative and postoperative situations in patients with

关 键 词：肿瘤 壶腹部 术前胆道引流 梗阻性黄疸 胰十二指肠切除术 手术相关并发症 

分 类 号：R656[医药卫生—外科学]