儿童胰腺肿瘤手术后发生临床相关性术后胰瘘的影响因素分析  

Risk factors for clinically relevant postoperative pancreatic fistula of pancreatic tumor in children

作　　者：张虹 白建喜 成海燕[2] 冯俊 杨深 秦红[2] 王焕民[2] 张炳 Zhang Hong;Bai Jianxi;Cheng Haiyan;Feng Jun;Yang Shen;Qin Hong;Wang Huanmin;Zhang Bing(Department of General Surgery,Fujian Children's Hospital,Fuzhou 350000,China;Department of Surgical Oncology,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]福建省儿童医院普外科,福州350000 [2]首都医科大学附属北京儿童医院肿瘤外科,北京100045

出　　处：《中华肝胆外科杂志》2023年第11期843-846,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的分析儿童胰腺肿瘤手术切除后发生临床相关性术后胰瘘(CR-POPF)的影响因素。方法回顾分析首都医科大学附属北京儿童医院2007年1月至2020年3月诊断为胰腺肿瘤并接受手术治疗患儿的临床资料。共入组患儿123例,其中男性39例,女性84例,年龄范围6岁8个月~11岁10个月,中位数9岁10个月。无胰瘘和生化漏患儿纳入对照组(n=95),B、C级胰瘘患儿纳入CR-POPF组(n=28)。单因素和多因素logistic回归分析CR-POPF的影响因素。结果123例患儿发生CR-POPF的患儿28例(22.8%),分别是B级胰瘘24例(85.7%,24/28),C级胰瘘4例(14.3%,4/28)。CR-POPF组与对照组患儿年龄>8岁4个月、肿瘤位于胰头、手术时间>390 min比例和手术方式比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析,结果显示年龄>8岁4个月(OR=8.226,95%CI:1.813~37.333,P=0.006)和行保留十二指肠的胰头切除术(OR=3.353,95%CI:1.282~8.767,P=0.014)的患儿手术切除后发生CR-POPF的风险升高。结论年龄>8岁4个月和行保留十二指肠的胰头切除术是胰腺肿瘤患儿手术后发生CR-POPF的危险因素。Objective To analyze the influencing factors of clinically relevant postoperative pancreatic fistula(CR-POPF)in children with pancreatic tumors after surgery.Methods The clinical data of 123 children undergoing surgery for pancreatic tumor in Beijing Children's Hospital,Capital Medical University from January 2007 to March 2020 were retrospectively analyzed,including 39 males and 84 females,with a median age of 9.8 years(6.7 to 11.8).Patients without pancreatic fistula and with biochemical leakage were included in control group(n=95),while patients with grade B and C pancreatic fistula were divided into CR-POPF group(n=28).The independent influencing factors of CR-POPF were analyzed by univariate and multivariate logistic regression.Results Among 123 children,28 cases(22.8%)developed CR-POPF,including 24 cases(85.7%,24/28)of grade B pancreatic fistula and 4 cases(14.3%,4/28)of grade C pancreatic fistula.There were significant differences between CR-POPF and control groups in the age>8 years and 4 months,tumor location,operation time>390 min and procedures(all P<0.05).Multivariate logistic regression analysis showed an increased risk of CR-POPF in children aged>8 years and 4 months(OR=8.226,95%CI:1.813-37.333,P=0.006)and undergoing duodenum-preserving pancreatic head resection(DPPHR)(OR=3.353,95%CI:1.282-8.767,P=0.014).Conclusion Age>8 years and 4 months and DPPHR are independent risk factors for CR-POPF in children with pancreatic tumors after surgery.

关 键 词：胰腺肿瘤 危险因素 儿童 临床相关性术后胰瘘 保留十二指肠的胰头切除术 

分 类 号：R735.9[医药卫生—肿瘤]