江苏省胰十二指肠切除手术情况和预后分析(附2886例报告)  

Analysis of surgical situations and prognosis of pancreaticoduodenectomy in Jiangsu province(a report of 2886 cases)

作　　者：陆子鹏 高鑫 程浩[3] 王宁 张凯 尹杰 尹凌帝 林佑廷 朱心睿 王东芝[7] 马红钦 刘同泰 徐永子 朱道俊 禹亚斌 杨扬[13] 刘飞[14] 潘超 唐劲草[16] 胡敏杰 华志元[18] 轩福明 夏磊洲 钱栋 王永 王苏苏 高文涛 仇毓东[3] 朱东明[2] 苗毅 蒋奎荣 江苏省胰腺专病质量控制中心 Lu Zipeng;Gao Xin;Cheng Hao;Wang Ning;Zhang Kai;Yin Jie;Yin Lingdi;Lin Youting;Zhu Xinrui;Wang Dongzhi;Ma Hongqin;Liu Tongtai;Xu Yongzi;Zhu Daojun;Yu Yabin;Yang Yang;Liu Fei;Pan Chao;Tang Jincao;Hu Minjie;Hua Zhiyuan;Xuan Fuming;Xia Leizhou;Qian Dong;Wang Yong;Wang Susu;Gao Wentao;Qiu Yudong;Zhu Dongming;Miao Yi;Jiang Kuirong;Pancreatic Disease Quality Control Center of Jiangsu Province(Pancreas Center,The First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital),Pancreas Institute of Nanjing Medical University,Nanjing 210029,China;Department of General Surgery,The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of General Surgery,Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China;Management Office of Quality Control Center of Jiangsu Provincial Health Commission,Nanjing 210008,China;Pancreas Center,BenQ Medical Center Affiliated to Nanjing Medical University,Nanjing 210019,China;Department of General Surgery,The First People′s Hospital of Changzhou,Changzhou 213004,China;Department of General Surgery,The Affiliated Hospital of Nantong University,Nantong 226006,China;Department of General Surgery,The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221004,China;Department of General Surgery,Northern Jiangsu People′s Hospital,Yangzhou 225009,China;Department of General Surgery,Jiangsu Cancer Hospital,Nanjing 210009,China;Department of General Surgery,General Hospital of Eastern Theater Command,Nanjing 210016,China;Department of General Surgery,Huai′an First People′s Hospital,Huai′an 223399,China;Department of General Surgery,Zhongda Hospital Southeast University,Nanjing 210009,China;Department of General Surgery,The First People′s Hospital of Lianyungang,Lianyungang 222002,China;Department of General Surgery,Nanjing First Hospital,Nanjing 210012,China;Department of General Surgery,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210003,China;Department of General Surgery,Taizhou People′s Hospita

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)胰腺中心、南京医科大学胰腺研究所,南京210029 [2]苏州大学附属第一医院普通外科,苏州215006 [3]南京大学医学院附属鼓楼医院普通外科,南京210008 [4]江苏省卫生健康委员会质量控制中心管理办公室,南京210008 [5]南京医科大学附属明基医院胰腺中心,南京210019 [6]常州市第一人民医院普通外科,常州213004 [7]南通大学附属医院普通外科,南通226006 [8]徐州医科大学附属医院普通外科,徐州221004 [9]苏北人民医院普通外科,扬州225009 [10]江苏省肿瘤医院普通外科,南京210009 [11]中国人民解放军东部战区总医院普通外科,南京210016 [12]淮安市第一人民医院普通外科,淮安223399 [13]东南大学附属中大医院普通外科,南京210009 [14]连云港市第一人民医院普通外科,连云港222002 [15]南京市第一医院普通外科,南京210012 [16]南京医科大学第二附属医院普通外科,南京210003 [17]南京医科大学附属泰州人民医院普通外科,泰州225399 [18]无锡市第二人民医院肝胆胰外科,无锡214001 [19]盐城市第一人民医院普通外科,盐城224006 [20]镇江市第一人民医院普通外科,镇江212002 [21]江苏省中医院普通外科,南京210004 [22]宿迁市第一人民医院普通外科,宿迁223812 [23]不详

出　　处：《中华消化外科杂志》2024年第5期685-693,共9页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82072706、82272974);江苏省自然科学基金(BK20221416);江苏省科教能力提升工程项目(ZDXK202222);江苏省人民医院临床能力提升工程项目(JSPH⁃MA⁃2020⁃5)。

摘　　要：目的探讨江苏省开展胰十二指肠切除术的手术情况和围手术期结局,分析术后90 d死亡的影响因素。方法采用回顾性病例对照研究方法。收集2021年3月至2022年12月江苏省胰腺专病质量控制中心中南京医科大学第一附属医院等21家大型三甲医院收治的2886例行胰十二指肠切除术患者的临床病理资料;男1732例,女1154例;年龄为65(57,71)岁。江苏省胰腺专病质量控制中心在江苏省胰腺疾病质量控制项目的框架之下,采用多中心注册登记研究方法,建立全省统一胰十二指肠切除电子数据库。观察指标:(1)临床特征。(2)术中和术后情况。(3)胰十二指肠切除术后90 d内死亡的影响因素分析。偏态分布的计量资料以M(Q1,Q3)或M(IQR)表示,组间比较采用Mann⁃Whitney U检验。计数资料以绝对数或构成比表示,组间比较采用χ^(2)检验、χ^(2)检验连续性校正、Fisher确切概率法。约登指数最大值确定连续变量最佳分界值。单因素分析根据数据类型采用对应的统计学方法。多因素分析采用Logistic多元回归模型。结果(1)临床特征。2886例行胰十二指肠切除术患者中,2021年和2022年分别为1175例和1711例。21家医院中,8家胰十二指肠切除术年均手术量<36例,10家年均手术量为36~119例,3家年均手术量≥120例。年均手术量≥36例的13家医院施行胰十二指肠切除术2584例,占总数89.536%(2584/2886);年均手术量≥120例的3家医院施行胰十二指肠切除术1357例,占总数47.020%(1357/2886)。(2)术中和术后情况。2886例患者中,手术入路为开腹2397例、微创488例、未知1例;保留幽门情况为保留871例、未保留1952例、未知63例;联合脏器切除情况为联合任何脏器切除305例(含血管切除209例)、未联合脏器切除2579例、未知2例。2885例手术时间为290(115)min,2882例术中出血量为240(250)mL,2880例术中输血率27.153%(782/2880)。2886例患者中,侵入性治疗率为11.3Objective To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods The retrospective case-control study was conducted.The clinicopathological data of 2886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases,including The First Affiliated Hospital of Nanjing Medical University,from March 2021 to December 2022 were collected.There were 1732 males and 1154 females,aged 65(57,71)years.Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project,the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancreaticoduodenectomy.Observation indicators:(1)clinical characteristics;(2)intraoperative and postoperative conditions;(3)influencing factors for 90-day mortality after pancreaticoduodenectomy.Measurement data with skewed distribution were represented as M(Q1,Q3)or M(IQR),and comparison between groups was conducted using the Mann-Whitney U test.Count data were expressed as absolute numbers or constituent ratio,and comparison between groups was conducted using the chi-square test,continuity correction chi-square test and Fisher exact probability.Maximal Youden index method was used to determine the cutoff value of continuous variables.Univariate analysis was performed using the corresponding statistical methods based on data types.Multivariate analysis was performed using the Logistic multiple regression model.Results(1)Clinical characteristics.Of the 2886 patients who underwent pancreaticoduodenectomy,there were 1175 and 1711 cases in 2021 and 2022,respectively.Of the 21 hospitals,8 hospitals had an average annual surgical volume of<36 cases for pancreaticoduodenectomy,10 hospitals had an average annual surgical volume of 36−119 cases,and 3 hospitals had an average annual surgical

关 键 词：胰腺肿瘤 胰十二指肠切除 围手术期 数据库 江苏省 

分 类 号：R657.5[医药卫生—外科学]