中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
8期
569-572
,共4页
腹壶周围疾病%胰十二指肠切除术%胰瘘%预测
腹壺週圍疾病%胰十二指腸切除術%胰瘺%預測
복호주위질병%이십이지장절제술%이루%예측
Pancreatic neoplasms%Pancreaticoduodenectomy%Fistula%Prediction
目的 探讨日本国立癌症中心医院(NCCH)建立的胰十二指肠切除术后胰瘘的术前预测系统(简称NCCH预测系统)的临床价值.方法 回顾性分析2008年10月至2012年1月天津医科大学附属肿瘤医院收治的100例术前诊断为壶腹周围肿瘤行胰十二指肠切除术患者的临床资料.NCCH预测系统纳入患者性别、胰腺癌、主胰管指数、门静脉受侵犯及腹腔内脂肪厚度5项指标,并将积分＞4分者定义为术后胰瘘高危人群；≤4分者为低危人群.对影响术后胰瘘发生的相关因素采用Pearsonx2检验进行统计分析.应用ROC曲线分析NCCH预测系统对患者术后胰瘘发生的敏感度和特异度.结果 本组100例患者中,20例术后发生胰瘘,其中A级9例、B级6例、C级5例.相关因素分析结果表明:性别、胰腺癌、门静脉受侵犯、胰腺质地及胰肠吻合方式等与术后胰瘘的发生密切相关(x2=5.613,4.785,15.479,7.145,7.050,P＜0.05).高危人群术后胰瘘发生率高达86.4％ (19/22),而低危人群术后胰瘘发生率仅为1.3％(1/78),两者比较,差异有统计学意义(x2=77.637,P＜0.05).ROC曲线分析表明:NCCH预测系统对术后胰瘘预测的敏感度、特异度分别达到95.0％和96.3％,ROC曲线下面积达99.0％ (P ＜0.05).结论 NCCH预测系统能够准确地预测严重胰瘘的发生.
目的 探討日本國立癌癥中心醫院(NCCH)建立的胰十二指腸切除術後胰瘺的術前預測繫統(簡稱NCCH預測繫統)的臨床價值.方法 迴顧性分析2008年10月至2012年1月天津醫科大學附屬腫瘤醫院收治的100例術前診斷為壺腹週圍腫瘤行胰十二指腸切除術患者的臨床資料.NCCH預測繫統納入患者性彆、胰腺癌、主胰管指數、門靜脈受侵犯及腹腔內脂肪厚度5項指標,併將積分＞4分者定義為術後胰瘺高危人群；≤4分者為低危人群.對影響術後胰瘺髮生的相關因素採用Pearsonx2檢驗進行統計分析.應用ROC麯線分析NCCH預測繫統對患者術後胰瘺髮生的敏感度和特異度.結果 本組100例患者中,20例術後髮生胰瘺,其中A級9例、B級6例、C級5例.相關因素分析結果錶明:性彆、胰腺癌、門靜脈受侵犯、胰腺質地及胰腸吻閤方式等與術後胰瘺的髮生密切相關(x2=5.613,4.785,15.479,7.145,7.050,P＜0.05).高危人群術後胰瘺髮生率高達86.4％ (19/22),而低危人群術後胰瘺髮生率僅為1.3％(1/78),兩者比較,差異有統計學意義(x2=77.637,P＜0.05).ROC麯線分析錶明:NCCH預測繫統對術後胰瘺預測的敏感度、特異度分彆達到95.0％和96.3％,ROC麯線下麵積達99.0％ (P ＜0.05).結論 NCCH預測繫統能夠準確地預測嚴重胰瘺的髮生.
목적 탐토일본국립암증중심의원(NCCH)건립적이십이지장절제술후이루적술전예측계통(간칭NCCH예측계통)적림상개치.방법 회고성분석2008년10월지2012년1월천진의과대학부속종류의원수치적100례술전진단위호복주위종류행이십이지장절제술환자적림상자료.NCCH예측계통납입환자성별、이선암、주이관지수、문정맥수침범급복강내지방후도5항지표,병장적분＞4분자정의위술후이루고위인군；≤4분자위저위인군.대영향술후이루발생적상관인소채용Pearsonx2검험진행통계분석.응용ROC곡선분석NCCH예측계통대환자술후이루발생적민감도화특이도.결과 본조100례환자중,20례술후발생이루,기중A급9례、B급6례、C급5례.상관인소분석결과표명:성별、이선암、문정맥수침범、이선질지급이장문합방식등여술후이루적발생밀절상관(x2=5.613,4.785,15.479,7.145,7.050,P＜0.05).고위인군술후이루발생솔고체86.4％ (19/22),이저위인군술후이루발생솔부위1.3％(1/78),량자비교,차이유통계학의의(x2=77.637,P＜0.05).ROC곡선분석표명:NCCH예측계통대술후이루예측적민감도、특이도분별체도95.0％화96.3％,ROC곡선하면적체99.0％ (P ＜0.05).결론 NCCH예측계통능구준학지예측엄중이루적발생.
Objective To investigate the clinical value of a preoperative predictive scoring system established by National Cancer Center Hospital (NCCH) for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).Methods The clinical data of 100 patients with periampullary tumor who underwent PD in the Cancer Hospital of Tianjin Medical University from October 2008 to January 2012 were retrospectively analyzed.Five indexes including gender,pancreatic cancer,main pancreatic duct index,portal invasion and intra-abdominal fat thickness were in the NCCH preoperative predictive scoring system.Patients with score ＞ 4 were defined as with high risk of POPF,and those with score≤4 were defined as with low risk of POPF.Factors associated with POPF were analyzed using the Pearson chi-square test.The sensitivity and specificity of the predictive scoring system were determined by receiver operating characteristic (ROC) curve analysis.Results Of the 100 patients,20 had POPF,including 9 in grade A,6 in grade B and 5 in grade C.Gender,pancreatic cancer,portal invasion,texture of pancreas and method of pancreaticojejunostomy were closely correlated with POPF (x2=5.613,4.785,15.479,7.145,7.050,P ＜ 0.05).The incidence of POPF was 86.4％ (19/22) for patients with high risk of POPF,and 1.3％ (1/78) for patients with low risk of POPF,with significant difference (x2=77.637,P ＜ 0.05).The results of ROC curve analysis showed that the sensitivity and specificity of the predictive scoring system were 95.0％ and 96.3％,respectively.The nomogram showed an area under the curve of 99.0％ (P ＜ 0.05).Conclusion The NCCH preoperative predictive scoring system could accurately predict the occurrence of POPF.
