胰腺术后胰瘘发生相关危险因素分析(附303例胰腺手术报告)

Related risk factors of pancreatic fistula after pancreatic surgery: A report of 303 cases

目的探讨影响病人胰腺手术后胰瘘发生率的危险因素。方法回顾性分析2012年2月至2015年1月中国医科大学附属第一医院收治的303例行胰腺手术病人资料,其中术后发生胰瘘50例。对影响术后胰瘘发生的相关因素进行单因素分析及Logistics回归分析。结果单因素分析结果显示,影响术后胰瘘发生的因素包括性别、病理类型、胰管扩张、手术时间、术中出血量、术前血红蛋白、术前血清总胆红素、术后血清总胆红素（P〈0.05）。非条件Logistic回归分析结果显示,影响术后胰瘘发生的独立危险因素为：性别（OR=12.001,95%CI 3.049-47.230,P〈0.05）、病理类型（OR=1.605,95%CI 1.108-2.324,P〈0.05）、胰管扩张（OR=1.177,95%CI 0.188-0.468,P〈0.05）、手术时间（OR=1.641,95%CI=1.173-2.339,P〈0.05）、术中出血量（OR=1.096,95%CI 1.094-1.099,P〈0.05）、术前血红蛋白（OR=0.888,95%CI 0.823-0.921,P〈0.05）、术前血清总胆红素（OR=1.359,95%CI 1.335-1.381,P=0.010）、术后血清总胆红素（OR=1.030,95%CI 1.064-1.004,P〈0.05）。结论男性、手术前后血清胆红素浓度高、壶腹部癌或十二指肠癌是胰瘘发生的独立危险因素,而胰管扩张则可减少胰腺手术后胰瘘的发生。

Objective To investigate the risk factors of pancreatic fistula in patients after pancreatic operation. Methods The clinical data of 303 cases of pancreatic operation performed from February 2012 to January 2015 in the First Hospital of China Medical University were analyzed retrospectively, included 50 postoperative pancreatic Fistula cases. The potential risk factors of pancreatic fistula were analyzed by univariate and multivariate Logistic regression analysis. Results The univariate analysis showed that the risk factors of pancreatic fistula included sex, pathological type, dilatation of pancreatic duct, operation time, intraoperative blood loss, preoperative Hb, preoperative and postoperative serum TBIL （P〈0.05）. The multivariate nonconditional Logistic regression analysis showed that the risk factors of pancreatic fistula included gender （OR = 12.001,95%CI 3.049-47.230, P=0.00）, duodenal cancer and vater cancer in pathological diagnosis（OR= 1.605,95%CI=1.108--2.324,P=0.00）, dilatation of pancreatic duct（OR ： 1.177, 95%CI 0.188--0.468, P=0.00）, time of surgery （OR=1.641,95%CI 1.173--2.339, P=0.00）,intraoperative blood loss （OR=1.096, 95% CI 1.094--1.099, P=0.00）,preoperative hemoglobin （OR=0.888, 95% CI 0.823--0.921, P=0.00）, preoperative serum total bilirubin（OR=1.359,95%CI 1.335--1.381, P=0.00）, postoperative serum total bilirubin （OR= 1.030, 95%CI 1.064--1.004, P=0.00）. Conclusion Male, high serum total bilirubin before and after surgery, duodenal cancer and vater cancer in pathological diagnosis are independent risk factors of the incidence of pancreatic fistula, and dilatation of the main pancreatic duct can reduce the risk of pancreatic fistula.