胰十二指肠切除术后胰瘘发生的相关因素分析

Risk factors of pancreatic fistula after pancreaticoduodenectomy

目的探讨胰十二指肠切除术后胰瘘发生的危险因素。方法回顾性分析2000年5月至2010年5月昆明医学院第二附属医院收治的186例行胰十二指肠切除术患者的临床资料，根据术后是否发生胰瘘将患者分成胰瘘组（39例）和非胰瘘组（147例）进行队列研究。对围手术期可能与胰瘘发生相关的多种因素进行分析，筛选胰十二指肠切除术后胰瘘发生的危险因素。单因素分析采用X^2检验或Fisher确切概率法，多因素分析采用Logistic回归模型。结果186例患者中39例发生胰瘘，其中A级26例、B级10例、C级3例。单因素分析结果显示：术前黄疸时间、术前6个月体质量下降、术前TBil、术前纠正后Alb、术后第3天Alb、胰腺残端游离长度、胰管直径、胰腺质地、腹腔引流管拔出时间是发生胰瘘的影响因素（X^2=34．990，20．480，8．212，10．890，13．561，11．505，13．820，4．539，36．590，P〈0．05）。多因素分析结果显示：术前黄疸时间〉8周、术前6个月体质量下降≥10％、胰管直径〈3mm、胰腺质地柔软、腹腔引流管拔出时间〉5d是发生胰瘘的独立危险因素（OR=2．229，3．383，1．437，1．273，11．939，P〈0．05）。结论术前黄疸时间〉8周、术前6个月内体质量下降≥10％、胰管直径〈3mm、胰腺质地柔软和腹腔引流管拔出时间〉5d将增加患者胰十二指肠切除术后胰瘘的发生率。

Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy （PD）. Methods The clinical data of 186 patients who received PD at the Second Affiliated Hospital of Kunming Medical College from May 2000 to May 2010 were retrospectively analyzed. All patients were divided into pancreatic fistula group （39 patients） and non-pancreatic fistula group （147 patients）. Risk factors of pancreatic fistula after PD were screened out from 20 factors by univariate and multivariate analysis. The univariate analysis was carried out by ehi-square test or Fisher exact test, and the multivariate analysis was done by Logistic regression. Results Thirty-nine patients were complicated with pancreatic fistula, including 26 in grade A, 10 in grade B and 3 in grade C. The results of univariate analysis showed that duration of preoperative jaundice, loss of body weight at 6 months before operation, preoperative total bilimbin level, preoperative albumin level, postoperative albumin level, length of pancreas dissected, pancreatic tube diameter, pancreatic texture and time of abdominal drainage tube pull out were high risk factors of pancreatic fistula （X^2 =34. 990, 20.480, 8. 212, 10.890, 13. 561, 11. 505, 13. 820, 4. 539, 36. 590, P 〈 0.05）. The results of multivariate analysis showed that duration of preoperative jaundice 〉 8 weeks, loss of body weight at 6 months before operation ≥ 10%, pancreatic tube diameter 〈 3 ram, soft pancreatic texture and time of abdominal drainage tube pull out 〉 5 days were the independent risk factors of pancreatic fistula （ OR = 2. 229, 3. 383, 1. 437, 1. 273, 11. 939, P 〈 0.05）. Conclusion Duration of preopera-tive jaundice 〉 8 weeks, unconscious loss of body weight t〉 10% within 6 months before operation, pancreatic tube diameter 〈 3 ram, soft pancreatic texture, time of abdominal drainage tube pull out 〉 5 days would increase the risk of pancreatic fistula after PD.