胰十二指肠切除术后胰瘘风险预测系统的建立和应用

Risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy and its predictive score

目的探讨胰十二指肠切除术后胰瘘的危险因素，建立胰瘘风险预测模型并验证其准确性。方法回顾性收集北京大学第一医院2008年1月至2015年4月连续的445例胰十二指肠切除术患者的临床资料，以3：1比例随机分为模型组和验证组。应用单因素及多因素分析筛选模型组患者术后胰瘘的风险因素，建立术后胰瘘的风险预测模型，并代入验证组验证其预测的准确性。结果模型组334例患者中，88例术后发生胰瘘，发生率26．4％。Logistic回归多因素分析结果提示，体重指数（P〈0．01）、术前CT所示胰管直径（P=0．001）为术后胰瘘发生的独立危险因素。据此建立胰十二指肠切除术后胰瘘风险预测模型，受试者工作特征曲线（ROC）下面积为0．829（95％CI：0．777～0．881）。代入验证组拟合ROC曲线下面积为0．885（95％CI：0．825～0．945），提示预测准确性良好。结论体重指数和术前CT所示胰管直径与胰十二指肠切除术后发生胰瘘有相关性。本研究建立的术后胰瘘风险预测模型具有良好的预测准确性，可为术中胰腺消化道重建、术后胰瘘的防控及处置提供参考及指导。

Objective To develop and test a scoring system to predict the risks of postoperative pancreatic fistula （POPF） after pancreaticoduodenectomy （PD）. Methods Clinic data and postoperative complications of the 445 consecutive patients who underwent a PD procedure between January 2008 and April 2015 in Peking University First Hospital were retrospectively collected and analyzed. The patients were randomly selected to modelling and validation sets at a ratio of 3 ： 1, respectively. The patient data were subjected to univariate and multivariate analysis in the modelling set of patients. A score predictive of POPF was designed and tested in the validation set. Results POPF occurred in 88 of 334 patients （26. 4% ） in the modelling set. The multivariate analysis showed that body mass index （ BMI, P 〈 0. 01 ） and pancreatic duct width （ P = 0. 001 ） are associated with POPF independently. A risk score to predict POPF was constructed based on these factors and successfully tested. The area under the receiver operating characteristic curve were 0. 829 （ 95% CI： 0. 777 - 0. 881 ） on the modelling set and 0. 885 （ 95% C,I： 0. 825-0. 945） on the validation set, respectively. Conclusions BMI and pancreatic duct width were associated with POPF after PD. The preoperative assessment of a patient＇s risk for POPF is feasible. The present risk score is a valid tool to predict POPF in patients undergoing PD, to make the selection on anastomosis types, and to take precautions against POPF.