晚期胰腺癌^(125)I粒子植入后胰瘘发生率及其影响因素分析

The incidence of pancreatic fistula after ^(125)I seed implantation in treatment of advanced pancreatic cancer and the influencing factors

目的探讨^(125)I粒子植入术治疗晚期胰腺癌术后胰瘘发生率及影响因素。方法 79例晚期胰腺癌病人行开腹^(125)I粒子植入术,根据术后是否发生胰瘘,分为发生胰瘘组和未发生组,记录两组病人一般情况,所有病人随访至2014年12月31日,记录病人生存时间。利用Logistic多因素分析对相关危险因素进行分析,利用Kaplan-Meier对病人生存期进行分析。结果 79例病人均顺利完成^(125)I粒子植入,均未出现死亡病例,未出现感染、出血等并发症,14例出现胰瘘,发生率为17.7%;单因素分析发现,肿瘤位置、放置粒子数和术后应用胰液分泌抑制药则是病人术后发生胰瘘的相关影响因素(P<0.05),多因素Logistic回归分析显示,肿瘤位置、放置粒子数和术后应用胰液分泌抑制药是影响病人术后发生胰瘘的独立危险因素(P<0.05);发生胰瘘组病人中位生存期为8.4个月,未发生组病人中位生存期为11.5个月,差异有统计学意义(P<0.05)。结论 ^(125)I粒子植入术可用于晚期胰腺癌病人治疗,粒子植入位置及数量、术后应用胰液分泌抑制药是影响术后胰瘘发生的因素,有效减少胰瘘发生可能对延长病人生存期具有重要意义。

Objective To investigate the incidence of pancreatic fistula after ^125I seed implanta- tion in treatment of advanced pancreatic cancer and the influencing factors. Methods Seventy-nine ca- ses of advanced pancreatic cancer undergoing transabdominal ^125I seed implantation were divided into pancreatic fistula group and control group. The general situations of the two groups were recorded. All patients were followed up to December 31, 2014, and the survival time was recorded. Logistic multivariate analysis was used to analyze the related risk factors. The survival time was analyzed by u- sing Kaplan-Meier. Results Seventy-nine patients were successfully subjected to ^125I seed implanta- tion. There were no deaths, infection, bleeding and other complications. Fourteen cases had pancreat- ic fistula with the incidence being 17. 7%. Univariate analysis showed that tumor location, the number of particles and postoperative medication inhibition of pancreatic secretion were related factors for postoperative pancreatic fistula （P 〈 0. 05）. Multivariate Logistic regression analysis showed that tumor location, the number of particles and postoperative medication inhibition of pancreatic secretion were independent risk factors for postoperative pancreatic fistula （P〈0. 05）. The median survival in pancreatic fistula group and control group was 8. 4 months, and 11.5 months, respectively （P〈 0. 05）. Conclusions ^125I seed implantation could be used to treat patients with advanced pancreatic cancer. Implantation location and quantity and postoperative medication inhibition of pancreatic secre- tion were the influence factors for the occurrence of postoperative pancreatic fistula. Effectively reduc- ing the incidence of pancreatic fistula might have important significance for prolonging survival time for patients.