全腹腔镜胰体尾切除术后胰瘘危险因素分析  

Analysis of risk factors of pancreatic fistula after total laparoscopic caudal pancreaticocaudectomy

作　　者：袁俊建[1] 柴伟[1] 张雷[1] 赵秀雷[1] 李金超 孟宇[1] YUAN Jun-jian;CHAI Wei;ZHANG Lei;ZHAO Xiu-lei;LI Jin-chao;MENG Yu(Department of Hepatobiliary Surgery,Cangzhou Cen-tral Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院肝胆胰外一科,河北沧州061000

出　　处：《临床军医杂志》2023年第8期786-789,793,共5页Clinical Journal of Medical Officers

基　　金：河北省2021年度医学科学研究课题计划(20210591)。

摘　　要：目的 探讨全腹腔镜胰体尾切除术后胰瘘的危险因素。方法 选取沧州市中心医院自2019年3月至2021年7月收治的120例行全腹腔镜胰体尾切除术患者为研究对象。记录所有患者全腹腔镜胰体尾切除术后胰瘘发生率。根据是否发生胰瘘将120例患者分为胰瘘组(n=27)与无胰瘘组(n=93)。比较胰瘘组与无胰瘘组患者的临床资料。采用多因素Logistic回归分析法检验全腹腔镜胰体尾切除术后胰瘘的危险因素。结果 120例患者均顺利完成全腹腔镜胰体尾切除术,术后胰瘘发生率为22.5%(27/120)。胰瘘组患者术前合并低蛋白血症、脾切除比例均高于无胰瘘组,差异均有统计学意义(P<0.05);两组患者胰腺肿瘤类型、胰管直径、残余胰腺质地比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前合并低蛋白血症、脾切除、胰腺肿瘤类型、胰管直径均为全腹腔镜胰体尾切除术后胰瘘的独立危险因素(P<0.05)。结论 全腹腔镜胰体尾切除术后胰瘘的发生风险较高,且术前合并低蛋白血症、脾切除、胰腺肿瘤类型、胰管直径均为其危险因素,临床可据此制定针对性防治措施,以减少术后胰瘘的发生。Objective To investigate the risk factors of pancreatic fistula after total laparoscopic pancreatococcygeal resection.Methods A total of 120 patients with total laparoscopic caudal pancreatectomy treated in Cangzhou Central Hospital from March 2019 to July 2021 were selected as the study objects.The incidence of pancreatic fistula after total laparoscopic pancreatococcygeal re-section was recorded in all patients.According to the occurrence of pancreatic fistula,120 patients were divided into pancreatic fistula group(n=27)and non-pancreatic fistula group(n=93).The clinical data of patients with pancreatic fistula and those without pancre-atic fistula were compared.Multivariate Logistic regression analysis was used to determine the risk factors of pancreatic fistula after to-tal laparoscopic pancreaticotail resection.Results All the 120 patients underwent total laparoscopic pancreatococcygeal resection.The incidence of postoperative pancreatic fistula was 22.5%(27/120).The proportion of patients with preoperative hypoproteinemia and splenectomy in pancreatic fistula group were higher than those in non-pancreatic fistula group,with statistical significance(P<0.05).There were statistically significant differences in pancreatic tumor type,pancreatic duct diameter and residual pancreatic texture be-tween two groups(P<0.05).Multivariate Logistic regression analysis showed that preoperative combined hypoproteinemia,splenecto-my,pancreatic tumor type,and pancreatic duct diameter were independent risk factors for pancreatic fistula after total laparoscopic co-caudectomy(P<0.05).Conclusion The risk of pancreatic fistula after total laparoscopic caudectomy is high,and preoperative hy-poproteinemia,splenectomy,pancreatic tumor type,and pancreatic duct diameter are all risk factors.Therefore,targeted prevention and treatment measures can be developed to reduce the incidence of postoperative pancreatic fistula.

关 键 词：全腹腔镜胰体尾切除术 术后胰瘘 低蛋白血症 胰管直径 脾切除 危险因素 

分 类 号：R657.5[医药卫生—外科学]