CAJ | 학술논문

目的探讨125I粒子植入治疗晚期胰腺癌患者术后发生胰瘘的相关因素.方法根据纳入和排除标准,回顾性统计分析我院2009年1月至2014年6月55例行术中125I粒子植入的晚期胰腺癌患者的临床资料,分为胰瘘组患者和非胰瘘组患者,并分别从年龄、性别、术前血清胆红素水平、术前血清白蛋白水平、是否合并糖尿病、手术时间、术中出血量、肿瘤大小、粒子植入位置、粒子植入数量、术后血清白蛋白水平、术后抑制胰液分泌的药物应用等方面进行单因素分析.若两组间存在两种或两种以上的因素差异具有统计学意义,则进一步采用多因素Logisitic回归分析.结果 55例行125I粒子植入术的患者中,无围手术期死亡病例,9例发生术后胰瘘,胰瘘发生率为16.4％.经单因素分析,年龄、性别、术前血清总胆红素水平、是否合并糖尿病、植入粒子数目、手术时间、围手术期血清白蛋白水平等因素与术后胰瘘发生无相关性(P＞0.05),术中125I粒子植入的位置及术后是否应用抑制胰液分泌药物与术后胰瘘的发生具有相关性(P＜0.05).经多因素Logisitic回归进一步分析,125I粒子植入的位置及术后是否应用抑制胰液分泌药物是术后发生胰瘘的独立危险因素.结论对于无法行根治性切除的晚期胰腺癌患者,125I粒子植入是一种安全、有效的治疗手段.肿物位于胰头颈部或钩突部是术后发生胰瘘的的危险因素.术后应用生长抑素或醋酸奥曲肽等抑制胰液分泌的药物可降低胰瘘的发生率.
목적 탐토125I입자식입치료만기이선암환자술후발생이루적상관인소.방법 근거납입화배제표준,회고성통계분석아원2009년1월지2014년6월55례행술중125I입자식입적만기이선암환자적림상자료,분위이루조환자화비이루조환자,병분별종년령、성별、술전혈청담홍소수평、술전혈청백단백수평、시부합병당뇨병、수술시간、술중출혈량、종류대소、입자식입위치、입자식입수량、술후혈청백단백수평、술후억제이액분비적약물응용등방면진행단인소분석.약량조간존재량충혹량충이상적인소차이구유통계학의의,칙진일보채용다인소Logisitic회귀분석.결과 55례행125I입자식입술적환자중,무위수술기사망병례,9례발생술후이루,이루발생솔위16.4％.경단인소분석,년령、성별、술전혈청총담홍소수평、시부합병당뇨병、식입입자수목、수술시간、위수술기혈청백단백수평등인소여술후이루발생무상관성(P＞0.05),술중125I입자식입적위치급술후시부응용억제이액분비약물여술후이루적발생구유상관성(P＜0.05).경다인소Logisitic회귀진일보분석,125I입자식입적위치급술후시부응용억제이액분비약물시술후발생이루적독립위험인소.결론 대우무법행근치성절제적만기이선암환자,125I입자식입시일충안전、유효적치료수단.종물위우이두경부혹구돌부시술후발생이루적적위험인소.술후응용생장억소혹작산오곡태등억제이액분비적약물가강저이루적발생솔.
Objective To explore the correlated risk factors of pancreatic fistula after 125I radioactive particles implantation for advanced pancreatic carcinoma.Methods Using pre-determined inclusion and exclusion criteria,we retrospectively studied the clinical data of 55 patients with advanced pancreatic carcinoma who underwent 125I radioactive particles implantation from January 2009 to June 2014.We divided these patients into two groups:the pancreatic fistula group and the non-pancreatic fistula group.We carried out single factor analysis on age,sex,preoperative serum total bilirubin,preoperative serum albumin,diabe-tes,operation time,volume of intro-operative bleeding,size of tumor,implant position,number of particles,postoperative serum albumin and drugs which inhibited secretion of pancreatic juice respectively.If two or more factors showed significant differences between the two groups,we did further Logistic regression analysis of the multifactors.Results There was no peri-operation death in the 55 patients who received 125I radioactive particles implantation.Pancreatic fistula occurred in 9 patients (16.4％).On single factor analysis,there was no correlation in postoperative pancreatic fistula between the two groups in the factors for age,sex,preoperative serum total bilirubin,diabetes,number of particles,operation time,peri-operative serum albumin (P ＞ 0.05).However,the factors of implant position and drugs that inhibited the secretion of pancreatic juice were significantly related to postoperative pancreatic fistula (P ＜ 0.05).On multifactor analysis,the implant position and drugs which inhibited the secretion of pancreatic juice were risk factors of postoperative pancreatic fistula.Conclusions 125I radioactive particles implantation was safe and efficacious for patients with advanced pancreatic carcinoma.Tumors located in the head or neck or uncinate process of pancreas,and drugs that inhibited secretion of pancreatic juice (somatostatin or octreotide acetate) significantly reduced the incidence of pancreatic fistula after operation.