胰十二指肠切除术后胰瘘风险预测模型的建立:基于2016新版胰瘘定义及分级系统  

Establishment of a risk prediction model for pancreatic fistula after pancreaticoduodenectomy:A study based on the 2016 edition of the definition and classification system of pancreatic fistula

作　　者：余俊 任超逸[1,2,3] 崔巍 时静祥[1,2] YU Jun;REN Chaoyi;CUI Wei;SHI Jingxiang(Department of Hepatobiliary Surgery,Tianjin Third Central Hospital,Tianjin 300170,China;Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Tianjin Third Central Hospital,Tianjin 300170,China;Artificial Cell Engineering Technology Research Center,Tianjin Third Central Hospital,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院肝胆外科,天津300170 [2]天津市第三中心医院天津市重症疾病体外生命支持重点实验室,天津300170 [3]天津市第三中心医院天津市人工细胞工程技术研究中心,天津300170

出　　处：《临床肝胆病杂志》2024年第4期773-781,共9页Journal of Clinical Hepatology

基　　金：天津市卫生健康科技项目(TJWJ2023MS016)。

摘　　要：目的比较分析2005版、2016版胰瘘定义及分级标准导致的胰十二指肠切除术(PD)术后胰瘘危险因素的差异,根据2016版胰瘘标准建立胰瘘风险预测模型。方法回顾性分析天津市第三中心医院2016年1月—2022年5月收治的303例行PD患者的临床资料,根据新、旧版胰瘘标准统计术后胰瘘患者,计量资料组间比较采用成组t检验或非参数检验Mann-Whitney U检验;计数资料组间比较采用χ^(2)检验。单因素及多因素Logistic回归分析筛选两版标准对PD患者术后胰瘘的危险因素的区别,基于2016新版标准建立术后胰瘘的风险预测模型,受试者工作特征曲线分析该模型预测术后胰瘘发生的准确性并验证该模型。结果2005版胰瘘标准:单因素分析显示主胰管直径(χ^(2)=31.641,P<0.001)、主胰管指数(χ^(2)=52.777,P<0.001)、门静脉侵犯(χ^(2)=6.259,P=0.012)、腹腔内脂肪厚度(χ^(2)=7.665,P=0.006)、术前胆道引流(χ^(2)=5.999,P=0.014)、胰腺癌(χ^(2)=5.544,P=0.019)、切缘胰腺厚度(t=2.055,P=0.032)、胰腺CT值(t=−3.224,P=0.002)、术前血淀粉酶水平(Z=−2.099,P=0.036)与术后胰瘘的发生相关,Logistic回归分析显示主胰管指数[OR(95%CI)=0.000(0.000~0.011)]、胰腺癌[OR(95%CI)=4.843(1.285~18.254)]、胰腺CT值[OR(95%CI)=0.869(0.806~0.937)]为独立危险因素(P值均<0.05);而基于2016版胰瘘标准:单因素分析显示主胰管直径(χ^(2)=5.391,P=0.020)、主胰管指数(χ^(2)=11.394,P=0.001)、腹腔内脂肪厚度(χ^(2)=8.899,P=0.003)、胰腺切缘厚度(t=2.665,P=0.009)、胰腺CT值(t=−2.835,P=0.004)与术后胰瘘的发生相关,Logistic回归分析显示主胰管指数[OR(95%CI)=0.001(0.000~0.050)]、胰腺CT值[OR(95%CI)=0.943(0.894~0.994)]为独立危险因素(P值均<0.05)。据此建立PD术后胰瘘风险预测模型,受试者工作特征曲线分析表明该模型预测PD术后胰瘘的曲线下面积在建模组与验证组分别为0.788(95%CI:0.707~0.870)和0.804(95%CI:0.675~0.932)。结论主�Objective To investigate the differences in the risk factors for postoperative pancreatic fistula(POPF)after pancreaticoduodenectomy(PD)between the 2005 and 2016 editions of the definition and classification standards for pancreatic fistula,and to establish a risk prediction model for pancreatic fistula based on the 2016 edition.Methods A retrospective analysis was performed for the clinical data of 303 patients who were admitted to Tianjin Third Central Hospital and underwent PD from January 2016 to May 2022,and the patients with POPF were identified based on the new and old editions.The independentsamples t test or the non-parametric Mann-Whitney U test was used for comparison of continuous data between groups,and the chisquare test was used for comparison of categorical data between groups.The univariate and multivariate logistic regression analyses were used to investigate the differences in the risk factors for pancreatic fistula after PD between the two editions;a risk prediction model was established for POPF based on the 2016 edition,and the receiver operating characteristic curve was used to invesitgate the accuracy of this model in predicting POPF and perform model validation.Results According to the 2005 edition,the univariate analysis showed that the diameter of the main pancreatic duct(χ^(2)=31.641,P<0.001),main pancreatic duct index(χ^(2)=52.777,P<0.001),portal vein invasion(χ^(2)=6.259,P=0.012),intra-abdominal fat thickness(χ^(2)=7.665,P=0.006),preoperative biliary drainage(χ^(2)=5.999,P=0.014),pancreatic cancer(χ^(2)=5.544,P=0.019),marginal pancreatic thickness(t=2.055,P=0.032),pancreatic CT value(t=−3.224,P=0.002),and preoperative blood amylase level(Z=−2.099,P=0.036)were closely associated with POPF,and the multivariate logistic regression analysis showed that main pancreatic duct index(odds ratio[OR]=0.000,95%confidence interval[CI]:0.000—0.011,P<0.05),pancreatic cancer(OR=4.843,95%CI:1.285—18.254,P<0.05),and pancreatic CT value(OR=0.869,95%CI:0.806—0.937,P<0.05)were independent

关 键 词：胰十二指肠切除术 胰腺瘘 胰腺管 预测 

分 类 号：R657.5[医药卫生—外科学]