胰十二指肠切除术后胰瘘发生的相关因素

Prognostic factors for pancreatic fistula following pancreaticoduodenectomy

目的探讨胰十二指肠切除术后胰瘘的发生情况及相关因素分析。方法回顾性分析解放军总医院2013年1-12月完成的196例胰十二指肠切除术临床资料,并对围术期可能与胰瘘发生相关的因素进行单因素分析和Logistic回归多因素分析。结果 196例胰十二指肠切除术后发生A级胰瘘62例(31.6%),B级胰瘘53例(27.0%),C级胰瘘11例(5.6%),总体胰瘘发生率高达64.3%,有临床意义的胰瘘(即B、C级胰瘘)64例,占32.7%。经单变量及多变量回归分析发现,胰管直径≤3 mm是总体胰瘘发生的独立风险因素,胰管直径≤3 mm和胰液内引流是有临床意义的胰瘘发生的独立风险因素。结论胰瘘仍然是胰十二指肠切除术后早期主要并发症,胰管直径≤3 mm是胰瘘发生的主要独立风险因素,胰液引流至体外可以降低临床胰瘘的发病率并减轻胰瘘的严重程度。

Objective To explore the morbidity and prognostic factors of postoperative pancreatic fistula （POPF） following pancreaticoduodenectomy （PD）.Methods Clinical data about 196 consecutive patients who underwent PD in Chinese PLA General Hospital from January 1,2013 to December 31,2013 were recorded retrospectively.Univariate analysis and multivariate logistic regression analysis were used to estimate relative risks.Results Of the 196 patients,POPF of grade A occurred in 62 patients （31.6％）,grade B in 53 patients （27.0％）,grade C in 11 cases （5.6％）,with a total incidence of 64.3％ （126/196） and the incidence of clinically relevant POPF （CR-POPF） was 32.7％ （64/196）.Univariate analysis and multivariate regression analysis showed that pancreatic duct diameter and POPF rates were significantly correlated,pancreatic duct diameter ≤ 3 mm was an independent risk factor for POPF.The CR-POPF rate was higher in patients without external pancreatic stent,furthermore,it was also an independent risk factor for CR-POPF.Conclusion POPF contributes to early postoperative morbidity and pancreatic duct diameter ≤ 3 mm is an independent risk factor of POPF.The external drainage of pancreatic secretion with an external stent across pancreaticojejunal anastomosis can significantly reduce the mortality of CR-POPF and alleviate the severity of POPF.