胰十二指肠切除术后发生胃排空延迟的危险因素分析

Risk factors for delayed gastric emptying after pancreaticoduodenectomy

目的分析胰十二指肠切除术后发生胃排空延迟（DGE）的相关危险因素。方法回顾性分析2009年1月至2014年12月宁波李惠利医院308例接受胰十二指肠切除术患者的临床资料。将308例患者分为DGE组及无DGE组，应用单因素分析及Logistic回归模型多因素分析法对围手术期可能发生DGE的相关因素进行分析。结果308例患者中55例术后发生DGE（17．9％），根据严重程度从轻到重分为A、B、C3级，其中A级22例（7．1％），B级19例（6．2％），C级14例（4．5％）。单因素分析结果显示，胰腺消化道重建方式（胰胃或胰肠吻合）、术后胰瘘、术后胆瘘及术后腹腔感染是术后发生DGE的危险因素。多因素分析结果显示，胰腺消化道重建方式（OR=1．19，P=0．046）、术后胰瘘（OR=1．33，P=0．014）、术后胆瘘（OR=1．43，P=0．047）及术后腹腔感染（OR=1．51，P=0．001）是术后发生DGE的独立危险因素；术后胰瘘（OR=3．692，P=0．021）及腹腔感染（OR=3．725，P=0．003）是发生B级和C级DGE的独立危险因素。结论DGE的发生与术后并发症密切相关。术后胰瘘、胆瘘及腹腔感染增加DGE的发生率，胰胃吻合由于其较低的术后胆、胰瘘发生率从而降低了DGE的发生率。

Objective To analyze the related risk factors for delayed gastric emptying （DGE） after pancreaticoduodenectomy. Methods Clinical data on 308 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili hospital from January 2009 to December 2014 were retrospectively analyzed, and patients were divided into DGE group and non-DGE group. Univariate analysis and multivariate logistic regression analysis were used to study the risk factors associated with DGE during perioperative period. Results DGE occurred in 55 patients （17.9%）. The incidences of grade A, grade B and grade C DGE were 7.1% （22/308）, 6.2% （19/308） and 4.5% （14/308）, respectively. The univariate analysis showed the method of pancreatic digestive tract reconstruction （pancreaticogastrostomy or pancreaticojejunostomy）, postoperative pancreatic fistula, postoperative biliary fistula and postoperative intraabdominal infection were risk factors for DGE after surgery. Multivariate analysis indicated that the method of pancreatic digestive tract reconstruction （ OR = 1.19, P =0.046）, postoperative pancreatic fistula （ OR = 1.33, P =0.014）, postoperative biliary fistula （ OR = 1.43, P = 0.047） and postoperative intraabdominal infection （ OR = 1,51, P = 0.001 ） were independently associated with DGE. Postoperative pancreatic fistula （OR = 3. 692, P = 0. 021 ） and intraabdominal infection （ OR = 3. 725, P = 0. 003 ） were also the independent risk factors for Grade B and Grade C DGE. Conclusions DGE after pancreaticoduodenectomy was strongly related to the postoperative complications. Postoperative pancreatic fistula, biliary fistula and intraabdominal infection were associated with increased risk of DGE, while pancreaticogastrostomy reduced the incidence of DGE by decreasing the incidence of pancreatic or biliary fistula.