中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
7期
531-534
,共4页
王伟珅%沈柏用%邓侠兴%詹茜%吴志翀%彭承宏
王偉珅%瀋柏用%鄧俠興%詹茜%吳誌翀%彭承宏
왕위신%침백용%산협흥%첨천%오지충%팽승굉
胰腺肿瘤%胰十二指肠切除术%胰瘘
胰腺腫瘤%胰十二指腸切除術%胰瘺
이선종류%이십이지장절제술%이루
Pancreatic neoplasms%Pancreaticoduodenectomy%Pancreatic fistula
目的 探讨胰十二指肠切除术后胰瘘发生的危险因素.方法 回顾性分析2005年1月至2013年5月上海交通大学医学院附属瑞金医院收治的310例施行胰十二指肠切除术患者的临床资料,并对围手术期可能与胰瘘有关的临床病理因素进行分析.单因素分析采用Pearson x2检验,多因素分析采用非条件Logistic回归模型.结果 310例患者中134例术后发生并发症,其中胰瘘发生率为33.23％(103/310),胰瘘患者中合并其他并发症者40例.单因素分析结果显示:术前Hb、术前TBil、胰管直径及术后Alb 4个因素是胰十二指肠切除术后胰瘘发生的危险因素(x2=4.543,6.087,6.265,5.311,P＜0.05).多因素分析结果显示:术前TBil ≥34.2 μmol/L、胰管直径＜3 mm及术后Alb＜ 28 g/L是胰十二指肠切除术后胰瘘发生的独立危险因素(OR=1.806,1.936,1.780;95％可信区间:1.107 ～2.948,1.170 ～3.206,1.002～3.165,P＜0.05).结论 术前显性黄疸(TBil≥34.2 μmol/L),胰管直径过小(＜3 mm)和术后营养情况不良(Alb ＜28 g/L)预示着胰十二指肠切除术后较高的胰瘘发生率.
目的 探討胰十二指腸切除術後胰瘺髮生的危險因素.方法 迴顧性分析2005年1月至2013年5月上海交通大學醫學院附屬瑞金醫院收治的310例施行胰十二指腸切除術患者的臨床資料,併對圍手術期可能與胰瘺有關的臨床病理因素進行分析.單因素分析採用Pearson x2檢驗,多因素分析採用非條件Logistic迴歸模型.結果 310例患者中134例術後髮生併髮癥,其中胰瘺髮生率為33.23％(103/310),胰瘺患者中閤併其他併髮癥者40例.單因素分析結果顯示:術前Hb、術前TBil、胰管直徑及術後Alb 4箇因素是胰十二指腸切除術後胰瘺髮生的危險因素(x2=4.543,6.087,6.265,5.311,P＜0.05).多因素分析結果顯示:術前TBil ≥34.2 μmol/L、胰管直徑＜3 mm及術後Alb＜ 28 g/L是胰十二指腸切除術後胰瘺髮生的獨立危險因素(OR=1.806,1.936,1.780;95％可信區間:1.107 ～2.948,1.170 ～3.206,1.002～3.165,P＜0.05).結論 術前顯性黃疸(TBil≥34.2 μmol/L),胰管直徑過小(＜3 mm)和術後營養情況不良(Alb ＜28 g/L)預示著胰十二指腸切除術後較高的胰瘺髮生率.
목적 탐토이십이지장절제술후이루발생적위험인소.방법 회고성분석2005년1월지2013년5월상해교통대학의학원부속서금의원수치적310례시행이십이지장절제술환자적림상자료,병대위수술기가능여이루유관적림상병리인소진행분석.단인소분석채용Pearson x2검험,다인소분석채용비조건Logistic회귀모형.결과 310례환자중134례술후발생병발증,기중이루발생솔위33.23％(103/310),이루환자중합병기타병발증자40례.단인소분석결과현시:술전Hb、술전TBil、이관직경급술후Alb 4개인소시이십이지장절제술후이루발생적위험인소(x2=4.543,6.087,6.265,5.311,P＜0.05).다인소분석결과현시:술전TBil ≥34.2 μmol/L、이관직경＜3 mm급술후Alb＜ 28 g/L시이십이지장절제술후이루발생적독립위험인소(OR=1.806,1.936,1.780;95％가신구간:1.107 ～2.948,1.170 ～3.206,1.002～3.165,P＜0.05).결론 술전현성황달(TBil≥34.2 μmol/L),이관직경과소(＜3 mm)화술후영양정황불량(Alb ＜28 g/L)예시착이십이지장절제술후교고적이루발생솔.
Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 310 patients who received pancreaticoduodenectomy at the Ruijin Hospital of Shanghai Jiaotong University from January 2005 to May 2013 were retrospectively analyzed.The risk factors associated with the interoperative pancreatic fistula were analyzed.The univariate and multivariate analysis were done using the Pearson chi-square test and non-conditional Logistic regression model.Results A total of 134 patients had postoperative complications,including 103 (33.23％) with pancreatic fistula,among them 40 patients developed additional complications.The results of univariate analysis showed that preoperative levels of hemoglobin,total bilirubin,diameter of the pancreatic duct and postoperative level of albumin were risk factors of pancreatic fistula after pancreaticoduodenectomy (x2 ＝ 4.543,6.087,6.265,5.311,P ＜ 0.05).The results of multivariate analysis showed that preoperative level of total bilirubin equal to or above 34.2 μmol/L,the diameter of the pancreatic duct under 3 mm and the level of postoperative albumin under 28 g/L were the independent risk factors of pancreatic fistula (OR =1.806,1.936,1.780; 95％ confidence interval:1.107-2.948,1.170-3.206,1.002-3.165,P ＜ 0.05).Conclusion Preoperative jaundice (the level of total bilirubin ≥ 34.2 umol/L),pancreatic duct diameter ＜ 3 mm and postoperative malnutrition (albumin ＜ 28 g/L) indicate a higher incidence of postoperative pancreatic fistula.
