CAJ | 학술논문

目的分析胰十二指肠切除术后胰瘘发生的危险因素,为临床有效降低术后并发症提供理论依据.方法回顾性分析2009年9月至2012年9月上海交通大学医学院附属仁济医院收治的352例因癌症行胰十二指肠切除术患者的临床资料,根据术后有无发生胰瘘将患者分为胰瘘组和非胰瘘组进行对列研究.对围手术期可能影响术后发生胰瘘的多种因素进行单因素分析及多变量Logistic回归分析.结果共49例胰十二指肠切除术后发生胰瘘,胰瘘发生率为13.9％ (49/352).经单因素及多因素分析,术后胰瘘的发生与患者性别和年龄、糖尿病病史、手术时间、术中出血量、是否血管切除重建、胰管是否留置支撑管、胰肠吻合时间、消化道重建方式等均无关;而胰腺质地脆、胰管直径＜3 mm、术前血清总胆红素水平＞ 171 μmol/L、术前黄疸持续时间超过8周、术前血清白蛋白水平＜30 g/L是影响术后胰瘘发生的独立危险因素(P值均＜0.05).结论胰腺质地、胰管直径、术前黄疸程度、黄疸持续时间及低蛋白血症是影响胰十二指肠切除术后胰瘘发生的危险因素.
목적 분석이십이지장절제술후이루발생적위험인소,위림상유효강저술후병발증제공이론의거.방법 회고성분석2009년9월지2012년9월상해교통대학의학원부속인제의원수치적352례인암증행이십이지장절제술환자적림상자료,근거술후유무발생이루장환자분위이루조화비이루조진행대렬연구.대위수술기가능영향술후발생이루적다충인소진행단인소분석급다변량Logistic회귀분석.결과 공49례이십이지장절제술후발생이루,이루발생솔위13.9％ (49/352).경단인소급다인소분석,술후이루적발생여환자성별화년령、당뇨병병사、수술시간、술중출혈량、시부혈관절제중건、이관시부류치지탱관、이장문합시간、소화도중건방식등균무관;이이선질지취、이관직경＜3 mm、술전혈청총담홍소수평＞ 171 μmol/L、술전황달지속시간초과8주、술전혈청백단백수평＜30 g/L시영향술후이루발생적독립위험인소(P치균＜0.05).결론 이선질지、이관직경、술전황달정도、황달지속시간급저단백혈증시영향이십이지장절제술후이루발생적위험인소.
Objective To analyze the risk factors of pancreatic fistula after pancreaticoduodenectomy,in order to provide evidence to reduce post-operative complication in clinical practice.Methods The clinical data of 352 patients with malignancy who received pancreaticoduodenectomy at the Shanghai Renji Hospital from September 2009 to September 2012 were retrospectively analyzed.The patients were divided into pancreatic fistula group and non-pancreatic fistula group.Peri-operative risk factors of pancreatic fistula after pancreaticoduodenectomy were analyzed by univariate and multivariate logistic regression analysis.Results Forty-nine cases of pancreatic fistula occurred,and the incidence rate of pancreatic fistula was 13.9％ (49/352).Univariate and multivariate logistic regression analysis showed sex,age,history of diabetes,operation time,intra-operative blood loss,vessel reconstruction,pancreatic tube placement,anastomosis time,type of digestive tract reconstruction were not risk factors of pancreatic fistula; however,brittle pancreatic tissue,diameter of pancreatic duct ＜3 mm,pre-operative total bilirubin level ＞ 171 μmol/l,duration of preoperative jaundice ＞ 8 weeks,pre-operative albumin level ＜30 g/L were the independent risk factors of pancreatic fistula (P ＜ 0.05).Conclusions Brittle pancreatic tissue,small pancreatic duct,high level of serum bilirubin,long duration of preoperative jaundice,low level of serum albumin are the independent risk factors of pancreatic fistula after pancreaticoduodenectomy.