中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2015年
6期
410-414
,共5页
杨骥%黄强%林先盛%刘臣海%胡俊%李瑞阳%汪超
楊驥%黃彊%林先盛%劉臣海%鬍俊%李瑞暘%汪超
양기%황강%림선성%류신해%호준%리서양%왕초
胰十二指肠切除术%胰腺瘘%预测价值
胰十二指腸切除術%胰腺瘺%預測價值
이십이지장절제술%이선루%예측개치
Pancreaticoduodenectomy%Pancreatic fistula%Predictive value
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(PD)术前胰瘘风险预测系统(简称NCCH预测系统)的临床应用价值.方法 回顾性分析安徽医科大学附属省立医院2008年2月至2014年2月收治的269例行胰十二指肠切除术的患者的临床资料.按照NCCH预测系统的5项指标(性别、胰腺癌、主胰管指数、腹腔脂肪厚度、门静脉侵犯)进行评分,其中>4分者定义为术后胰瘘高危人群,≤4分者定义为术后胰瘘低危人群,并对影响术后胰瘘的非重复特征性因素进行临床分析.计数资料和计量资料的比较分别采用x2检验和t检验.通过单因素和多因素Logistic回归分析术后发生胰瘘的危险因素.应用ROC曲线分析NCCH预测系统预测患者术后胰瘘发生的灵敏度和特异度.结果 269例患者中,33例术后发生胰瘘,其中A级15例、B级11例、C级7例.PD术后胰瘘的单因素分析结果显示,PD术后胰瘘与性别、术前胆红素水平、是否胰腺癌、门静脉是否受侵犯、胰腺质地、主胰管直径和胰腺空肠吻合方式有关(P<0.05).多因素分析结果显示,性别、门静脉侵犯、胰腺质地、主胰管直径是影响PD术后胰瘘的独立危险因素(P<0.05).高危人群术后胰瘘发生率(53.8%,14/26)与低危人群术后胰瘘发生率(7.8%,19/243)相比,差异有统计学意义(x2 =46.231,P <0.01).ROC曲线分析结果表明,NCCH预测系统预测PD术后胰瘘的灵敏度为87.9%,特异度为94.1%,曲线下面积为0.946(95% CI:0.895 ~0.997).结论 NCCH预测系统可以在术前预测胰瘘的发生,但仍需大样本、多中心、前瞻性随机对照研究进一步明确NCCH预测系统的临床价值.
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(PD)術前胰瘺風險預測繫統(簡稱NCCH預測繫統)的臨床應用價值.方法 迴顧性分析安徽醫科大學附屬省立醫院2008年2月至2014年2月收治的269例行胰十二指腸切除術的患者的臨床資料.按照NCCH預測繫統的5項指標(性彆、胰腺癌、主胰管指數、腹腔脂肪厚度、門靜脈侵犯)進行評分,其中>4分者定義為術後胰瘺高危人群,≤4分者定義為術後胰瘺低危人群,併對影響術後胰瘺的非重複特徵性因素進行臨床分析.計數資料和計量資料的比較分彆採用x2檢驗和t檢驗.通過單因素和多因素Logistic迴歸分析術後髮生胰瘺的危險因素.應用ROC麯線分析NCCH預測繫統預測患者術後胰瘺髮生的靈敏度和特異度.結果 269例患者中,33例術後髮生胰瘺,其中A級15例、B級11例、C級7例.PD術後胰瘺的單因素分析結果顯示,PD術後胰瘺與性彆、術前膽紅素水平、是否胰腺癌、門靜脈是否受侵犯、胰腺質地、主胰管直徑和胰腺空腸吻閤方式有關(P<0.05).多因素分析結果顯示,性彆、門靜脈侵犯、胰腺質地、主胰管直徑是影響PD術後胰瘺的獨立危險因素(P<0.05).高危人群術後胰瘺髮生率(53.8%,14/26)與低危人群術後胰瘺髮生率(7.8%,19/243)相比,差異有統計學意義(x2 =46.231,P <0.01).ROC麯線分析結果錶明,NCCH預測繫統預測PD術後胰瘺的靈敏度為87.9%,特異度為94.1%,麯線下麵積為0.946(95% CI:0.895 ~0.997).結論 NCCH預測繫統可以在術前預測胰瘺的髮生,但仍需大樣本、多中心、前瞻性隨機對照研究進一步明確NCCH預測繫統的臨床價值.
목적 탐토일본국립암증중심의원(NCCH)건립적이십이지장절제술(PD)술전이루풍험예측계통(간칭NCCH예측계통)적림상응용개치.방법 회고성분석안휘의과대학부속성립의원2008년2월지2014년2월수치적269례행이십이지장절제술적환자적림상자료.안조NCCH예측계통적5항지표(성별、이선암、주이관지수、복강지방후도、문정맥침범)진행평분,기중>4분자정의위술후이루고위인군,≤4분자정의위술후이루저위인군,병대영향술후이루적비중복특정성인소진행림상분석.계수자료화계량자료적비교분별채용x2검험화t검험.통과단인소화다인소Logistic회귀분석술후발생이루적위험인소.응용ROC곡선분석NCCH예측계통예측환자술후이루발생적령민도화특이도.결과 269례환자중,33례술후발생이루,기중A급15례、B급11례、C급7례.PD술후이루적단인소분석결과현시,PD술후이루여성별、술전담홍소수평、시부이선암、문정맥시부수침범、이선질지、주이관직경화이선공장문합방식유관(P<0.05).다인소분석결과현시,성별、문정맥침범、이선질지、주이관직경시영향PD술후이루적독립위험인소(P<0.05).고위인군술후이루발생솔(53.8%,14/26)여저위인군술후이루발생솔(7.8%,19/243)상비,차이유통계학의의(x2 =46.231,P <0.01).ROC곡선분석결과표명,NCCH예측계통예측PD술후이루적령민도위87.9%,특이도위94.1%,곡선하면적위0.946(95% CI:0.895 ~0.997).결론 NCCH예측계통가이재술전예측이루적발생,단잉수대양본、다중심、전첨성수궤대조연구진일보명학NCCH예측계통적림상개치.
Objective To evaluate the clinical value of a preoperative predictive scoring system which was established by the National Cancer Center Hospital(NCCH) for the postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy.Methods The clinical data of 269 patients who underwent pancreaticoduodenectomy at the Affiliated Provincial Hospital of Anhui Medical University from February 2008 to February 2014 were studied retroprospectively.The five indexes which including gender,portal invasion,pancreatic cancer,main pancreatic duct index and intra abdominal fat thickness were calculated in the NCCH predictive score system.Patients with a score over 4 were defined as high risk of POPF,and those with score less than 4 were defined as low risk of POPF.Then the factors associated with POPF were analyzed by Logistic regression test.The enumeration data and measurement data were compared with x2 test and t test.Risk factors for postoperative pancreatic fistula were analyzed through single factor and multiple factors Logistic regression analysis.The sensitivity and specificity of the predictive scoring system were determined by receiver operating characteristic (ROC)curve analysis.Results A total of 33 patients were diagnosed as POPF,including 15 in grade A,11 in grade B and 7 in grade C.The univariate analysis showed that the factors associated with POPF are gender,total serum bilirubin level,pancreatic cancer,portal invasion,the pancreatic texture,main pancreatic duct diameter and the pancreaticojejunostomy.The multivariate analysis showed that gender,pancreatic texture,portal invasion and main pancreatic duct diameter were the independent risk factor of POPF.The rate of pancreatic fistula of high risk group was 53.8% (14/26),and the rate of pancreatic fistula of the low risk group was 7.8% (19/243).There were significant differences in the pancreatic fistula rate between the high risk and low risk of POPF(x2 =46.231,P < 0.01).The results of ROC curve analysis showed that the sensitivity and specificity of the predictive scoring system were 87.9% and 94.1%,respectively.The area under the curve was 0.946 (95% CI:0.895-0.997).Conclusions The NCCH preoperative predictive scoring system could accurately predict the occurrence of POPF.While large,multicenter prospective randomized controlled trials is still needed to further confirm it.