CAJ | 학술논문

目的分析胰十二指肠切除术中应用端侧胰管空肠黏膜-黏膜吻合法术后胰瘘的危险因素.方法回顾性分析我院1994年1月至2008年1月问101例胰十二指肠切除术病例,分析影响胰瘘的术前及术中危险因素. 结果本组胰瘘发生率为9.9%(10/101),单变量分析结果表明术前黄疸程度(χ2=5.814,P=0.016)、黄疸持续时间(χ2=4.17,P=0.041)、胰腺质地(χ2=5.286,P=0.021)、胰管直径(χ2=4.165,P=0.041)、手术失血量(χ2=5.273,P=0.022)是胰瘘发生的危险因素,多因素Logistic回归分析结果表明,胰腺质地(OR=13.355,P=0.023)、术前黄疸程度(OR=12.126,P=0.006)、手术失血量(OR=5.92,P=0.032)是胰瘘发生的独立危险因素.Logistic回归预测方程:P=1/[<1+e-(-6.378+2.592胰腺质地+2.495术前黄疽程度+1.778手术失血量)],此方程预测发生胰瘘的正确性为92.1%.结论胰腺质地、术前黄疸程度、手术失血最是端侧胰管空肠黏膜-黏膜吻合法术后胰瘘发生的独立危险因素,手术技术提高,减少术中失血量,可降低胰瘘的发生率.
목적 분석이십이지장절제술중응용단측이관공장점막-점막문합법술후이루적위험인소.방법 회고성분석아원1994년1월지2008년1월문101례이십이지장절제술병례,분석영향이루적술전급술중위험인소. 결과본조이루발생솔위9.9%(10/101),단변량분석결과표명술전황달정도(χ2=5.814,P=0.016)、황달지속시간(χ2=4.17,P=0.041)、이선질지(χ2=5.286,P=0.021)、이관직경(χ2=4.165,P=0.041)、수술실혈량(χ2=5.273,P=0.022)시이루발생적위험인소,다인소Logistic회귀분석결과표명,이선질지(OR=13.355,P=0.023)、술전황달정도(OR=12.126,P=0.006)、수술실혈량(OR=5.92,P=0.032)시이루발생적독립위험인소.Logistic회귀예측방정:P=1/[<1+e-(-6.378+2.592이선질지+2.495술전황저정도+1.778수술실혈량)],차방정예측발생이루적정학성위92.1%.결론 이선질지、술전황달정도、수술실혈최시단측이관공장점막-점막문합법술후이루발생적독립위험인소,수술기술제고,감소술중실혈량,가강저이루적발생솔.
Objective To investigate the risk factors for pancreatic fistula after duct-to-mucosa pancreaticojejuuostomy (PD). Methods The clinical data of 101 cases undergoing duct-to-mucosa PD in our hospital from January 1994 to January 2008 were reviewed retrospectively. Results The incidence of pancreatic fistula was 9.9% (10/101). Univariate analysis showed level of preoperative jaundice(χ2=5.814, P= 0.016) , duration of jaundice (χ2= 4.17, P = 0.041 ), texture of the remnant pancreas (χ2=5.286, P = 0.021 ), diameter of pancreatic duct (χ2= 4.165, P = 0.041 ), blood loss during operation (χ2=5.273, P=0.022) were significantly associated with pancreatic fistula after duct-to-mucosa PD. Multivariate analysis regression revealed that texture of the remnant pancreas (OR = 13.355, P = 0.023), level of preoperative jaundice (OR = 12.126, P = 0.006), blood loss during operation (OR = 5.92, P =0.032 ) were independent risk factors. Logistic regression equation was as following: P=1/[<1+e-(-6.378+2.592 texture of the remrant pancress + 2.495 level of preopetative jaundice + 1.778 blood loss during operative)>]. The accuracy of the logistic equation was 92.1%. Conclusion Texture of the remnant pancreas, level of preoperative jaundice, blood loss during operation were the independent risk factors for the occurrence of PD after duct-to-mucosa PD. Improvement of operative technique and reduction of blood loss can decrease the incidence of pancreatic fistula.