胰十二指肠切除术后临床胰瘘的危险因素分析及预测评价  

Risk factors analysis and predictive evaluation of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy

作　　者：滕达 许悦 杨青松 张文俊 TENG Da;XU Yue;YANG Qingsong;ZHANG Wenjun(Department of Hepatobiliary Pancreatic and Splenic Surgery WardⅠ,the Affiliated Chuzhou Hospital of Anhui Medical University,Chuzhou 239001,China;Department of Ultrasound Medicine,the Affiliated Chuzhou Hospital of Anhui Medical University,Chuzhou 239001,China)

机构地区：[1]安徽医科大学附属滁州医院肝胆胰脾外科一病区,安徽滁州239001 [2]安徽医科大学附属滁州医院超声医学中心,安徽滁州239001

出　　处：《大连医科大学学报》2024年第2期124-131,共8页Journal of Dalian Medical University

摘　　要：目的探讨胰十二指肠切除术(PD)术后临床胰瘘(CR-POPF)发生的危险因素,明确胰瘘风险评分(FRS)和术后第1天腹腔引流液淀粉酶(DFA1)预测CR-POPF的可行性及效能。方法回顾性分析2016年1月至2022年1月安徽医科大学附属滁州医院肝胆胰脾外科一病区接受PD的105例患者的临床资料,根据是否发生CR-POPF分为CR-POPF组和非CR-POPF组。通过单因素和多因素分析明确PD术后发生CR-POPF的危险因素,应用ROC曲线验证FRS和DFA1对术后发生CR-POPF的预测价值。将FRS分值细化为低分段组(0~2分)和中高分段组(3~10分),比较不同分段组中围手术期诊疗进程及并发症发生情况。结果共有28例(26.7%)患者发生CR-POPF。单因素及多因素分析结果显示,FRS为PD术后发生CR-POPF的独立危险因素(OR=3.278,95%CI 2.021~5.319,P<0.001)。FRS预测术后CR-POPF的曲线下面积为0.911(95%CI 0.857~0.965,P<0.001),敏感度和特异度分别为0.857和0.844。进一步分析FRS中各项指标,显示患者胰腺质地和胰管直径与CR-POPF明显相关(P<0.05)。FRS中高分段组术后CR-POPF和感染发生率远高于低分段组,差异具有统计学意义(P<0.05);中高分段组术后拔管和住院时间延长,二次入院率和住院死亡率更高,差异具有统计学意义(P<0.05)。根据DFA1数值绘制ROC曲线,得出曲线下面积为0.777(95%CI 0.673~0.882,P<0.001),计算约登指数,临界值为1526.16 U/L,预测CR-POPF的敏感度和特异度分别为0.714和0.753。结论FRS是影响PD术后发生CR-POPF的独立危险因素,FRS和DFA1可准确预测CR-POPF的发生。对于FRS≥3分、DFA1>1526.16 U/L的患者应早期预防,强化围手术期管理,个性化选择干预和治疗措施。Objective To study the adverse risk factors for clinically relevant postoperative pancreatic fistula(CR-POPF)after pancreaticoduodenectomy(PD),determine the fistula risk score(FRS),and assess the predictive efficacy of amylase level in abdominal drainage fluid on postoperative day 1(DFA1).Methods A retrospective analysis was conducted on the clinical data of 105 patients,who underwent PD accepted in the Department of Hepatobiliary Pancreatic and Splenic Surgery WardⅠat the Affiliated Chuzhou Hospital of Anhui Medical University from January 2016 to January 2022.According to whether CR-POPF occurred,the patients were divided into CR-POPF group and non CR-POPF group.Univariate and multivariate analyses were performed to identify adverse risk factors affecting CR-POPF after PD.The predictive value of FRS and DFA1 for CR-POPF after surgery was validated using receiver operating characteristic curve(ROC).Based on FRS score,the patients were further divided into low segmentation group(0-2 points)and medium to high segmentation group(3-10 points).The perioperative diagnosis,treatment progress and occurrence of complications were compared between different segmentation groups.Results A total of 28 patients(26.7%)developed CR-POPF.Univariate and multivariate analysis revealed that FRS was an independent risk factor for CR-POPF after PD(OR=3.278,95%CI 2.021-5.319,P<0.001).The area under the ROC curve for FRC predicting CR-POPF was 0.911(95%CI 0.857-0.965,P<0.001),with sensitivity and specificity of 0.857 and 0.844,respectively.Further analysis of the various indicators in FRS showed that pancreatic texture and pancreatic duct diameter were significantly associated with CR-POPF(P<0.05).The incidence of postoperative CR-POPF and infection in the middle-to-high segmentation group of FRS was much higher than that in the low segmentation group(P<0.05).At the same time,the middle-to-high segmentation group had longer postoperative extubation and hospitalization time,higher readmission rate and in-hospital mortality rate(P<0.05

关 键 词：胰十二指肠切除术 胰腺瘘 胰瘘风险评分 预测 

分 类 号：R657.5[医药卫生—外科学]