保留器官功能的胰腺切除术后胆道并发症发生危险因素分析  

Risk factors of biliary complications after organ-preserving pancreatectomy

作　　者：冀旭 朱峰[1] 冯业晨[1] Ji Xu;Zhu Feng;Feng Yechen(Department of Biliary and Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,武汉430030

出　　处：《中华肝脏外科手术学电子杂志》2024年第4期509-514,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金面上项目(81772950,82073249)

摘　　要：目的探讨保留器官功能的胰腺切除术后胆道并发症发生的影响因素。方法回顾性分析2015年5月到2022年4月在华中科技大学同济医学院附属同济医院行保留器官功能的胰腺切除术的210例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男79例,女131例。根据有无并发症分为胆道并发症组和非胆道并发症组,其中胆道并发症组50例,平均年龄(39±4)岁;非胆道并发症组160例,平均年龄(37±3)岁。所有患者均随访至术后90 d,比较两组围手术期指标差异,并分析术后胆道并发症发生的影响因素。两组手术方式比较采用χ^(2)检验,术后胆道并发症发生的独立影响因素分析采用Logistic回归分析。结果纳入的病例术后90 d内胆道并发症发生率23.8%(50/210)。术后胆道并发症发生与手术方式、肿瘤部位、肿瘤大小、胰腺质地、手术时间有关,其中肿瘤局部剜除术患者胆道并发症发生率最低4%(2/50)(χ^(2)=14.19,P<0.05)。Logistic回归分析显示,术前糖尿病史、术后ALT升高、术后AST升高、术后进食半流食时间延长及奥曲肽使用总量增多是术后胆道并发症发生的独立危险因素(OR=2.63,1.03,1.02,1.06,1.14;P<0.05)。结论术前糖尿病史、术后进食半流食时间、奥曲肽的使用量是保留器官功能的胰腺切除术后胆道系统并发症发生的独立危险因素。手术方式、肿瘤大小及胰腺质地与术后胆道并发症有关。术前控制好血糖,尽可能选择肿瘤局部剜除术,减少生长抑素类似物的使用以降低胆道系统并发症发生风险。Objective To investigate the risk factors of biliary complications after organ-preserving pancreatectomy.Methods Clinical data of 210 patients who underwent organ-preserving pancreatectomy in Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 2015 to April 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,79 patients were male and131 female.According to the incidence of complications,all patients were divided into the biliary complication group and non-biliary complication group.50 patients were assigned into the biliary complication group,aged(39±4)years on average,and 160 cases in the non-biliary complication group,aged(37±3)years on average.All patients were followed up for 90 d after surgery.The differences in perioperative indexes were compared between two groups.The risk factors of postoperative biliary complications were also analyzed.Surgical methods between two groups were compared by Chi-square test.The independent risk factors of postoperative biliary complications were assessed by Logistic regression analysis.Results The incidence of biliary complications within postoperative 90 d was 23.8%(50/210).The incidence of postoperative biliary complications was associated with surgical method,tumor site,tumor size,pancreatic texture,operative time.The incidence of biliary complications in patients treated with local tumoral enucleation was 4%(2/50),the lowest among all groups(χ^(2)=14.19,P<0.05).Logistic regression analysis showed that history of preoperative diabetes mellitus,postoperative ALT elevation,postoperative AST elevation,prolonged postoperative taking of semi-liquid diet and increased total dosage of octreotide were the independent risk factors for postoperative biliary complications(OR=2.63,1.03,1.02,1.06,1.14;P<0.05).Conclusions History of preoperative diabetes mellitus,time of postoperative semi-liquid diet and dosage of octreotide

关 键 词：胰腺切除术 保留器官功能 胆道并发症 危险因素 

分 类 号：R657.5[医药卫生—外科学]