放置胰管外引流的胰十二指肠切除术后胰瘘原因分析

Analysing Factors Causing Pancreatic Fistula post Pancreaticoduodenectomy with External Drainage of Pancreatic Duct

目的探讨放置胰管外引流的胰十二指肠切除术后胰瘘发生的原因。方法收集1999年——2011年行胰十二指肠切除术并放置胰管外引流的133例患者资料,分析其性别、年龄、合并冠心病、合并高血压、合并糖尿病、合并胆管炎、术前白蛋白(ALB)、总胆红素(TBIL)、术前胆管引流、胰管直径、胰管引流通畅与否、病理类型和术后是否应用生长抑素与发生胰瘘的关系。结果 133例患者中24例(18.05%)术后发生胰瘘,其中A级3例,B级13例,C级8例。24例患者中胰管引流通畅(通畅组)和不畅(不畅组)各12例。不畅组胰瘘的严重程度高于通畅组。除胰管引流不畅患者胰瘘发生率高于胰管引流通畅者(30.8%vs 12.8%,χ2=6.041,P<0.05)外,不同性别、年龄等其他因素间胰瘘发生率差异均无统计学意义。Logistic回归分析显示,胰管引流不畅是术后胰瘘发生的独立危险因素。结论胰管引流不畅是放置胰管外引流的胰十二指肠切除术后发生胰瘘的主要原因,保持术后胰管引流畅通可明显减少胰瘘的发生及胰瘘的严重程度。

Objective To analyze relevant factors causing pancreatic fistula post pancreaticoduodenectomy with ex-ternal drainage of pancreatic duct. Methods Altogether 133 patients who underwent pancreaticoduodenectomy with exter-nal drainage of pancreatic duct in our hospital from 1999 to 2011 were retrospectively analyzed. Logistic regression analysis was used to analyze the relevance of pancreatic fistula with age, gender, combined diseases, pancreatic duct diameter, patho-logical types, preoperative total bilirubin （TBIL）, albumin （ALB） levels, drainage of the bile duct before operation, obstruc-tion of the pancreatic duct drainage and postoperative application of growth somatostatin. Then we also analyzed the relation-ship between those risk factors and the severity of pancreatic fistula. Results Postoperative pancreatic fistula occurred in 24 cases （3 cases were of grade A,13 cases were of grade B and 8 cases were of grade C） among the 133 patients. Logistic re-gression analysis showed that obstruction of the pancreatic duct drainage is a major risk factor of pancreatic fistula in these patients（OR=4.529,P=0.005）. The patients whose pancreatic duct drainage was obstructed had a significantly higher pan-creatic fistula rate than the patients whose drainage was not obstructed （30.8%vs 12.8%, P＆lt;0.05）. The occurrence of pan-creatic fistula has no significant correlation with age, gender, combined diseases, pancreatic duct diameter, pathological types, preoperative TBIL, ALB level, preoperative bile duct drainage and postoperative application of somatostatin. What’s more, in those pancreatic fistula patients, the pancreatic fistulas were more severe in the obstructed ones than those in the un-obstructed ones. Conclusion The obstruction of the pancreatic duct drainage is a major risk factor of pancreatic fistula post pancreaticoduodenectomy with external drainage of pancreatic duct. If adequate preventive measures were employed during operation , the incidence of pancreatic fistula and pancreatic fistula severity will be significantly reduced.