胰十二指肠切除术后胰瘘发生的危险因素分析

Pancreatic fistula after pancreaticoduodenectomy: analysis of risk factors

目的:探讨胰十二指肠切除术(PD)后导致胰瘘(PF)发生的危险因素,为临床上PD后PF的防治提供参考。方法:回顾2010年1月—2014年03月期间新疆医科大学附属肿瘤医院收治的122例行PD术患者的临床资料,针对可能与PF相关的14个危险因素进行单因素及多因素Logistic回归分析。结果:全组PF发生率为13.9%(17/122)。单因素分析结果显示,上腹部手术史(P=0.024),术前胆红素(P=0.003)、术中出血量(P=0.023)、术后血红蛋白(P=0.021)、胰腺质地(P=0.046)、胰管直径(P=0.007)为PD后发生PF有意义的因素。多因素分析结果表明,上腹部手术史、胰管直径<3 mm、术后血红蛋白<90 g/L是PD术后发生PF的独立危险因素(OR=4.308、5.052、3.958,均P<0.05)。结论:对于上腹部手术史、胰管直径<3 mm、术后血红蛋白<90 g/L的PD患者,应采取相应的措施,减少术后PF的发生。

Objective：To investigate the risk factors for occurrence of pancreatic fistula（PF） after pancreaticoduodenectomy（PD）,so as to provide reference for prevention of PF after PD in clinical practice.Methods：The clinical data of 122 patients undergoing PD in Cancer Hospital affiliated to Xinjiang Medical University from January 2010 to march 2014 were reviewed.Fourteen factors potentially affecting the occurrence of PF were determined by univariate and multivariate Logistic regression analysis.Results：The incidence of PF in the whole group was 13.9%（17/122）.Univariate analysis showed that history of upper abdominal surgery（P=0.024）,preoperative bilirubin level（P=0.003）,intraoperative blood loss（P=0.023）,postoperative hemoglobin level（P=0.02l）,postoperative albumin level（P=0.046）,and pancreatic duct diameter（P=0.007） were significantly associated with PF after PD.Multivariate analysis results demonstrated that the history of abdominal surgery pancreatic duct diameter less than 3 mm,and postoperative hemoglobin level less than 90 g/L were independent risk factors for the occurrence of PF after PD（OR=4.308,5.052,3.958,all P0.05）.Conclusion：For PD patients with history of upper abdominal surgery,or with pancreatic duct diameter less than3 mm or postoperative hemoglobin level less than 90 g/L,appropriate measures should be taken to reduce the incidence of PF after PD.