胰十二指肠切除术后胰瘘的多因素分析

Multivariate analysis of risk factors of pancreatic fistula after pancreaticoduodenectomy

目的探讨胰十二指肠切除术(PD)术后胰瘘(PF)发生的危险因素。方法回顾性分析5年间在湘雅二医院行PD的137例患者的临床资料,并对围手术期可能与PF有关的18个因素进行单因素及逐步Logistic多因素分析。结果全组术后并发症发生率为32.1%(44/137),病死率6.57%(9/137);其中,胰瘘18例,发生率为13.1%,占总并发症的41.0%;死亡4例,占胰瘘病例的22.2%(4/8),占总死亡病例的44.4%(4/9)。PE组的并发症发生率及病死率均显著高于非PE组(均P<0.05)。Logistic多因素分析表明,胰瘘发生的独立危险因素为上腹部手术史(OR=6.741),术前TIBL≥171μmol/L(OR=3.308),胰腺质地软(OR=3.556)及胰管直径<3mm(OR=6.106)。结论术前重度黄疸(TIBL≥171μmol/L)、上腹部手术史及胰管直径细小和胰腺质地软预示着较高的胰瘘发生率。

Objective To investigate the risk factors of pancreatic fistula（PF） after pancreaticoduodenectomy（PD）. Methods One hundred and thirty-seven patients who underwent PD consectively at the second Xiangya hospital from January 2003 to January 2008 were reviewed retrospectively.The management and outcomes of patients with PF were also evaluated.Eighteen factors which potentially affect the occurrence of PF were analyzed with univariate and multivariate Logistic regression model. Results Of the 137 patients,the overall morbidity and hospital mortality was 32.1%（44/137） and 6.57%（9/137）respectively,and PF occurred in 18 patients（13.1%）.PF accounted for 41% of the overall morbidity.Multivariate Logistic regression analysis revealed that previous surgery in upper abdomen（OR=6.741）,pre-operative TIBL≥171μmol/L（OR=3.308）,soft texture of the pancreas（OR=3.556） and pancreatic duct diameter 3 mm（OR= 6.106） were independent risk factors for pancreatic fistula. Conclusions Pre-operative TIBL≥171 μmol/L,previous upper abdomenal surgery,small pancreatic duct diameter and soft texture of pancreas predict a high probability of pancreatic fistula after PD.