胰肠吻合方式对胰十二指肠切除术后胰瘘的影响

Effect of different pancreaticojejunal anastomoses on the occurrence of pancreatic fistula after pancreaticoduodenectomy

目的:探讨胰肠吻合方式对胰十二指肠切除术后胰瘘的影响。方法:回顾性分析2008年10月至2013年8月天津医科大学肿瘤医院收治的145例术前诊断为壶腹周围肿瘤行胰十二指肠切除术患者的临床资料。对影响术后胰瘘发生的相关因素进行统计分析。结果:本组患者中27例术后发生胰瘘。在4种胰肠吻合方式中,胰管空肠黏膜吻合和Blumgart吻合的胰瘘发生率低,且皆无C级胰瘘。多因素分析应用Logistic回归,结果表明不同的胰肠吻合方式及性别为术后胰瘘发生的独立预后因素。结论:胰肠吻合方式是影响胰十二指肠切除术后胰瘘发生的危险因素。

Objective： To investigate the effect of pancreaticojejunostomy on the occurrence of postoperative pancreatic fistula （POPF） after pancreaticoduodenectomy. Methods： Data from 145 patients with periampullary tumor who underwent pancreaticoduodenectomy in Tianjin Medical University Cancer Institute and Hospital between October 2008 and August 2013 were reviewed. Factors potentially associated with POPF were analyzed by Pearson chi-square test and Logistic regression analysis. Results： Among the 145 patients, 27 were diagnosed with POPF, including 5 grade A, 17 grade B and 5 grade C. Neither duct to mucosa nor Blumgart pancreati- cojejunostomy was correlated with POPF in grade C. The univariate analysis showed that gender, pancreatic cancer, portal vein involvement, type of pancreaticojejunostomy, texture of pancreas, and diameter of the main pancreatic duct were closely correlated with POPF. The multivariate analysis using Logistic regression showed that different pancreaticojejunal anastomoses and genders were independent predictors of POPF. Conclusion： Different types of pancreatic anastomoses are a risk factor for POPF after pancreaticoduodenectomy.