胰十二指肠切除术后胰瘘发生的危险因素分析

杜汉朋; 陈伟; 黄力; 张昆松; 梁力建; 赖佳明

doi:10.3760/cma.j.issn.1673-9752.2018.07.016

摘要: 目的:探讨胰十二指肠切除术后胰瘘发生的危险因素。
方法:采用回顾性病例对照研究方法。收集2011年1月至2015年12月中山大学附属第一医院收治的310例行胰十二指肠切除术患者的临床病理资料。观察指标：(1)随访情况。(2)影响胰十二指肠切除术后胰瘘发生的危险因素分析。采用门诊和电话方式进行随访，了解患者胰十二指肠切除术后胰瘘发生情况及有无因胰瘘引起的二次住院或死亡情况。随访时间截至2016年6月。单因素分析采用x²检验，多因素分析采用Logistic回归模型。
结果:(1)随访情况：310例患者均获得随访，随访时间为6～60个月，中位随访时间为31个月。随访期间，65例患者发生胰瘘，包括B级胰瘘59例，C级胰瘘6例。其中24例接受保守治疗，41例接受B超引导下置管引流术。63例患者经治疗后好转，痊愈出院；2例C级胰瘘患者因胰瘘相关并发症死亡。(2)影响胰十二指肠切除术后胰瘘发生的危险因素分析。单因素分析结果显示：合并高血压病、术者行胰十二指肠切除术例数、手术时间及胰肠吻合方式是影响胰十二指肠切除术后胰瘘发生的相关因素(x²=5.986，13.006，9.025，21.561，P<0.05)。多因素分析结果显示：合并高血压病、手术时间>6 h、胰肠吻合方式为端端胰肠套入式吻合或捆绑式胰肠吻合是影响胰十二指肠切除术后胰瘘发生的独立危险因素(优势比=2.465，1.880，2.719，6.190，95%可信区间：1.253～4.850，1.025～3.448，1.254～5.894，2.309～16.592，P<0.05)。
结论:合并高血压病、手术时间>6 h、胰肠吻合方式为端端胰肠套入式吻合或捆绑式胰肠吻合是影响胰十二指肠切除术后胰瘘发生的独立危险因素。

Abstract: Objective:To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.
Methods:The retrospective casecontrol study was conducted. The clinicopathological data of 310 patients who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Sun YatSen University between January 2011 and December 2015 were collected. Observation indicators: (1) followup situations; (2) risk factors analysis of pancreatic fistula after pancreaticoduodenectomy. Followup using outpatient examination and telephone interview was performed to detect occurrence of pancreatic fistula and pancreatic fistulainduced rehospitalization or death up to June 2016. The univariate and multivariate analyses were respectively done using the chisquare test and logistic regression model.
Results:(1) Followup situations: 310 patients were followed up for 6-60 months, with a median time of 31 months. During the followup, 65 patients were complicated with pancreatic fistula, including 59 in grade B and 6 in grade C. Twentyfour patients received conservative treatment, and 41 received B ultrasoundguided catheter drainage. Of 65 patients, 63 were improved and then discharged form hospital; 2 in grade C of pancreatic fistula died of pancreatic fistularelated complications. (2) Risk factors analysis of pancreatic fistula after pancreaticoduodenectomy: univariate analysis showed that combined hypertension, cases with pancreaticoduodenectomy, operation time and pancreaticojejunostomy method were related factors affecting pancreatic fistula after pancreaticoduodenectomy (x²=5.986, 13.006, 9.025, 21.561, P<0.05). The multivariate analysis showed that combined hypertension, operation time > 6 hours and endtoend telescopic pancreaticojejunostomy or binding pancreaticojejunostomy were independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy (Odds ratio=2.465, 1.880, 2.719, 6.190, 95% confidence interval: 1.253-4.850, 1.025-3.448, 1.254-5.894, 2.309-16.592, P<0.05).
Conclusion:The combined hypertension, operation time > 6 hours and endtoend telescopic pancreaticojejunostomy or binding pancreaticojejunostomy are independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy.