胰十二指肠切除术后胰瘘的危险因素分析

Analysis of risk factors for pancreatic leakage after pancreaticoduodenectomy

目的分析胰十二指肠切除术后胰瘘的危险因素,探讨黏膜-黏膜胰肠吻合减少术后胰瘘的可能性。方法回顾性研究我院2000年1月至2004年4月间85例胰十二指肠切除术病例,分析影响胰瘘的术前及术中危险因素,比较不同胰肠吻合方式对胰瘘的影响。结果术后胰瘘总发生率16.5%(14/85),其中黏膜-黏膜组3.57%(1/28),传统套入组22.8%(13/57)。统计学分析显示,胰肠吻合方式、胰管直径及残余胰腺质地为影响胰瘘发生的显著因素;多因素Logistic回归分析表明,胰管直径和胰腺质地为影响胰瘘发生的独立危险因素,P值分别为0.013和0.009,相对危险度(OR)分别为5.276和8.538。结论胰肠吻合方式、胰管直径和胰腺质地是影响胰十二指肠切除术后胰瘘的危险因素,对胰管扩张者(≥3mm)行黏膜-黏膜吻合可显著降低术后胰瘘的发生率,是一种安全可靠的胰肠吻合方法。

Objective To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy and explore whether duct-to-mucosa pancreaticojejunostomy can reduce the risk of pancreatic leakage. Methods Eighty-five patients receiving pancreaticoduodenectomy in our hospital between January 2000 and April 2004 were reviewed. Seven preoperative and 6 intraoperative risk factors for pancreatic leakage were analyzed to find out the relationship between anastomotic techniques and pancreatic leakage. Results Pancreaticojejunal anastomotic leakage was found in 14 out of the 85 patients (16.5%), 3.57% (1/28) of the patients undergoing duct-to-mucosa pancreaticojejunostomy and 22.8% (13/57) of those receiving invagination pancreaticojejunostomy. Anastomotic techniques, pancreatic duct size and texture of the remnant pancreas were identified as significant risk factors for pancreatic leakage by means of univariate analysis. The multivariate logistic regression analysis revealed that pancreatic duct size and texture of the remnant pancreas turned out to be independent risk factors (P:0.013 and 0.0009, OR: 5.276 and 8.538). Conclusions Anastomotic techniques, pancreatic duct size and texture of remnant pancreas are risk factors for pancreatic leakage after pancreaticoduodenectomy. Duct-to-mucosa pancreaticojejunostomy, as a safe and useful anastomotic technique, can reduce pancreatic leakage rate after pancreaticoduodenectomy.