腹腔镜胃肠道手术后高淀粉酶血症的临床意义及相关因素分析

Hyperamylasaemla after laparoscopic gastrointestinal surgery

目的探讨腹腔镜胃肠道手术后高淀粉酶血症发生的临床意义及相关因素。方法收集2011年3月至2012年6月在青岛大学医学院附属医院普外科行腹腔镜胃肠道手术200例患者的临床资料，根据手术后血清淀粉酶是否高于正常值分为高淀粉酶血症组和血淀粉酶正常组，观察手术后并发症发生情况。选择可能引起血清淀粉酶升高的22项因素先应用T检验、χ2检验进行单因素分析，将单因素分析中有统计学意义的变量纳入进行多因素Logistic回归分析。结果本组200例患者中出现术后高淀粉酶血症94例（47％），其中胃部手术有59例（56％），结直肠手术35例（37％）。发生手术后并发症22例（11％），高淀粉酶血症组15例（16％）（包括1例急性胰腺炎病例），血淀粉酶正常组7例（7％），两组比较差异有统计学意义（x2=4．452，P=0．035）。单因素分析显示：两组的BMI〉25kg／m2、上腹部手术、手术方式、手术体位、手术时间、处理胰腺操作、CO2气腹压力、气腹持续时间8项变量相比差异有统计学意义（P〈0．1）。多因素Logistic回归分析显示：两组手术时间、上腹部手术、CO2气腹压力、气腹持续时间4个变量相比差异有统计学意义（P〈0．05）。结论腹腔镜术后高淀粉酶血症的发生率较高，术后感染等并发症发生的风险明显增加。上腹部手术、较高的CO2气腹压力、较长的手术时间及气腹时间是腹腔镜术后发生高淀粉酶血症的独立危险因素。

Objective to investigate the clinical significance and risk factors of the hyperamylasemia after laparoscopic gastrointestinal operation. Methods In this study 200 patients undergoing laparoscopic gastrointestinal surgery between March 2011 and July 2012 were divided into two groups based on serum amylase level. The postoperative complications were observed. Hyperamlasemia was defined as more than 110 IU/L. Factors related with hyperamylasemia were selected and t-test, chi-square test were used for univariate analysis. Statistically significant variables was used for multivariate logistic regression analysis. Results Of 200 patients, 94 cases （47%） had postoperative hyperamylasemia including 59 cases（56% ） of gastrectomy and 35 cases （37%） of colorectal surgery. 22 cases （ 11% ） developed post-operative complications, there were 15 cases （16%） from hyperamylasemia group including one case of acute pancreatitis, and 7 patients （7%） from euamylasemia group （ X2 = 4. 452, P = 0. 035 ）. Univariate analysis showed that BMI （ body mass index） 〉 25 kg/m2, upper abdominal surgery, surgical approach, patient position, duration of operation, resection of pancreas capsule, CO2 pneumoperitoneum pressure and pneumoperitoneum duration were significant factors （ P 〈 0. 1 ）. Logistic regression analysis revealed that the length of operation, upper abdominal surgery, CO2 pneumoperitoneum pressure and duration of pneumoperitoneum were related to postoperative hyperamylasemia （ P 〈 0. 05 ）. Conclusions There was high incidence of postoperative hyperamlasemia in laparascopic procedures leading to increased risk of postoperative complications, such as infection. Upper abdominal surgery, CO2 pneumoperitoneum pressure, longer operation and pneumoperitoneum time are independent risk factors related with t）ostot）erative hvDeramvlasemia after la^aroscopic ~astrointestinal surgery.