影响胃癌术后胰瘘的围手术期危险因素分析

Perioperative risk factors for postoperative pancreatic fistula in patients with gastric cancer

目的：探讨可能影响胃癌术后发生胰瘘的围手术期因素。方法选取2010年1月至2015年6月643例于解放军第三零九医院行胃癌根治术的患者临床资料，按术后是否发生胰瘘分为术后胰瘘（POPF）组（53例）和非术后胰瘘（NPOPF）组（590例）。统计分析两组患者术前、术中和术后等围手术期资料。结果 POPF发生率为8．24％（53／643）。 POPF组和NPOPF组患者性别、年龄、术前合并症、术前血清白蛋白、TNM分期、腹部手术史、手术方式、淋巴结清扫方式、消化道重建方式、手术入路、失血量及住院时间比较差异均无统计学意义（P均＞0．05）。 POPF组 BMI（25．63±2．54） kg／m2高于NPOPF组的（21．11±2．44） kg／m2，差异有统计学意义（t＝2．245，P＝0．025）。 POPF组淋巴结清扫数目为（32．25±5．82）枚，NPOPF组为（27．06±6．79）枚，两组比较差异有统计学意义（t＝2．093，P＝0．037）。POPF组手术时间为（242．50±52．30） min，NPOPF组为（229．51±59．21） min，两组比较差异有统计学意义（t＝2．398，P＝0．017）。 POPF 组术后1 d 血清 CRP 为（85．72±12．05） mg／L，NPOPF 组为（76．41±12．52） mg／L，两组比较差异有统计学意义（ t＝1．979，P＝0．048）。 POPF组术后2～4 d血清白蛋白为（26．0±5．9） g／L，NPOPF组为（32．6±6．8） g／L，两组比较差异有统计学意义（t＝－10．185，P＝0．000）。POPF组术后1、2 d引流液淀粉酶为（2094±1444） U／L，NPOPF组为（746±486） U／L，两组比较差异有统计学意义（ t＝10．400，P＝0．000）。 Logistic分析结果表明，BMI、淋巴结清扫数目、手术时间、术后1、2 d引流液淀粉酶及术后第2～4天血清白蛋白均是术后发生胰瘘的危险因素（ OR值分别为1．972、1．836、2．004、0．150、9．809，P均＜0．05）。结论 BMI、淋巴结清扫数目、手术时间、术后2～4 d血清白蛋白和术后1、2天引流液淀粉酶可作为预测POPF发生的指标，有重要的临床意义。

Objective To explore perioperative risk factors for postoperative pancreatic fistu-la. Methods Six hundred and forty-three cases patients who underwent radical gastrectomy for gastric cancer from January 2010 to June 2015 in the NO. 309 Hospital of Chinese People’ s Liberation Army were selected and divided into Postoperative Pancreatic Fistula（ POPF） group with 53 cases and Non-Postoperative Pancreatic Fis-tula（ NPOPF） group with 590 cases. Preoperative,intraoperative and postoperative data were analyzed by statisti-cal analysis of two groups. Results POPF rate was 8. 24%（53/643）. There were no significanct differences in terms of gender,age,preoperation with disease,preoperative serum albumin,TNM stage,abdominal surgery,sur-gical procedure,lymph node dissection,digestive tract reconstruction,surgical approach,blood loss and length of time between the POPF group and NPOP group（P〉0. 05）. The level of BMI of POPF group was higher than that of NPOPF group,the difference was statistically significant（（25. 63±2. 54） kg/m2 vs. （21. 11±2. 44） kg/m2,t=2. 245,P=0. 025）. The number of lymph node dissection in POPF group was （32. 25±5. 82）,in NPOPF group was （27. 06±6. 79）,there was significant difference between the two groups（t=2. 093,P=0. 037）. The operation time in POPF group was （242. 50±52. 30） min,in NPOPF group was （229. 51±59. 21） min,the difference was statistically significant between the two groups（ t=2. 398,P=0. 017） . The serum CRP of 1 d in POPF group was （85. 72±12. 05） mg/L,in NPOPF group was （76. 41±12. 52） mg/L,and there was significant difference between the two groups（ t=1. 979,P=0. 048） . The serum albumin of 2-4 d after operation in POPF group was （26. 0±5. 9） g/L,in NPOPF group was （32. 6±6. 8） g/L,the difference between the two groups was statistically significant（t=-10. 185,P=0. 000）. The drainage fluid amylase of 1 and 2 d after operation in POPF group was （2094＋1444） U/L,in NPOPF group was （746＋486） U/L,and there was significant difference be-tween the two groups（ t=10. 400,P=0. 000） . Logistic regression analysis results showed that body mass index （ BMI） ,lymph node dissection number,time of operation,postoperative 1,2 d drainage fluid amylase and serum albumin of 2-4 d after operation were postoperative occurred pancreatic fistula risk factors（ OR=1. 972,183. 6, 2. 004,0. 150,9. 809,P〉0. 05）. Conclusion BMI,number of dissected lymph node,duration of surgery,serum albumin of 2-4 d after operation and postoperative 1,2 d drainage fluid amylase have important clinical values for predicted POPF.