影响胰十二指肠切除术后胰漏的因素分析

The Correlation between Pancreatic Leakage and Factors after Pancreaticoduodenectomy

目的:分析影响胰十二指肠切除术(PD)后胰漏的因素。方法:分析PD 136例病患术前、后与胰漏发生相关因素进行分析。结果:PD术后胰漏发生率为23.5%(32/136),因胰漏有关的死亡率为50%(2/4)。单因素分析显示性别、年龄、手术方式、胰空肠吻合方式、手术时间、胰管内支架放置方式与胰漏的发生无关(P>0.05)。细胰管(直径<3mm)、术前DBIL(≥170μmol/L)、胰腺质软、胰头癌型病患和术前ALB(≥30g/L)与胰漏发生显著相关(P<0.05或P<0.01)。多因素分析显示术前ALB(≥30g/L)、术前DBIL(≥170μmol/L)、细胰管(直径<3mm)、软质胰腺和胰头癌病患行PD术后容易发生胰漏(P<0.05或P<0.01)。结论:综合考虑病患的术前ALB、术前DBIL、胰管直径、胰腺质地和胰头癌等指标,采用"个体化"的防治措施,可最大限度降低胰漏的发生。

Objective：To analyze the correlation between pancreatic leakage and factors after pancreaticoduodenectomy（PD）. Methods： 136 cases of patients in our hospital underwent PD were collected. The factors affected the pancreatic leakage were analyzed. Results：Pancreatic leakage rate after PD was of 23.5%（32/136） and pancreatic leak-related mortality rate was of 50%（2/4）. Unvaried analysis showed that the gender, age, surgical approach, pancreatic jejunostomy, surgical time and pancreatic duct stent placement had no relationship with pancreatic leakage（P〉0.05）. Smaller pancreatic duct （diameter 〈3 mm）, preoperative DBIL （≥170μmol/L）, pancreas soft texture, preoperative ALB （≥30g/L） and ancreatic cancer were closely related pancreatic leakage （P〈0.05 or P〈0.01）. Multivariate analysis displayed the preoperative ALB （≥30g/L）, preoperative DBIL （≥ 170 μmol/L）, smaller pancreatic duct （diameter 〈 3 mm）, soft texture of the pancreas and pancreatic cancer had significantly correlation with pancreatic leakage after PD （P〈0.05 or P〈0.01）. Conclusion： Considering the preoperative ALB, DBIL, pancreatic duct diameter, pancreas texture and pancreatic cancer, “individualized” prevention and control measures can be applied to reduce the incidence of pancreatic leakage.