胰十二指肠切除术后胃排空延迟预后预测系统的建立和应用

Prognostic factors of postoperative delayed gastric emptying after pancreaticoduodenectomy：a predictive model

目的 探讨胰十二指肠切除术（PD）后胃排空延迟（DGE）的预后因素,建立DGE预后预测模型并验证其准确性.方法 回顾性收集2012年1月至2016年7月在哈尔滨医科大学附属第一医院胰胆外科行PD手术的401例患者的临床资料,以3：1的比例分为模型组（n=299）和验证组（n=102）.应用单因素及多因素分析筛选模型组患者PD术后发生DGE的预后因素并建立预测模型,验证组用于验证预测模型的准确性.结果 模型组299例患者中,35例术后发生DGE,发生率为11.7％.Logistic回归多因素分析结果显示,上腹部手术史（x2=6.533,P=0.011）、合并糖尿病（x2=17.872,P=0.000）、术前血红蛋白＜90 g/L（x2=14.608,P=0.000）及保留幽门的胰十二指肠切除术（PPPD） （x2 =8.811,P=0.003）为发生DGE的独立预后因素.根据此结果建立PD术后发生DGE的预后预测模型,受试者工作特征（ROC）曲线下面积为0.761（95％ CI：0.666～0.856）.验证组ROC曲线下面积为0.750（95％ CI：0.577～0.923）,提示预测准确性良好.结论 上腹部手术史、合并糖尿病、术前血红蛋白＜90 g/L及PPPD为发生DGE的独立预后因素.PD术后DGE预后预测模型具有良好的预测准确性,可为术后DGE的预防及治疗提供临床参考.

Objective To study the prognostic factors of delayed gastric emptying （DGE） after pancreaticoduodenectomy（PD） and construct a prognostic predictive model for clinical application.Methods Clinic data of 401 consecutive patients who underwent PD between January 2012 and July 2016 in the First Affiliated Hospital of Harbin Medical University were retrospectively collected and analyzed.The patients were randomly selected to modeling group（n =299） and validation group （n =102） at a ratio of 3：1.The data of modeling group were subjected to univariate and multivariate analysis for prognostic factors and to construct a prognostic predictive model of DGE after PD.The data of validation group were applied to test the prognostic predictive model.Results DGE after PD occurred in 35 of 299 patients （11.7%） in the modeling group.The multivariate analysis of the modeling group showed that upper abdominal operation history（x2 =6.533,P =0.011）,diabetes mellitus （x2 =17.872,P =0.000）,preoperative hemoglobin 〈 90 g/L （x2 =14.608,P =0.000） and pylorus-preserving pancreaticoduodenectomy （PPPD） （x2 =8.811,P=0.003） were associated with DGE after PD independently.A prognostic predictive model of DGE after PD was constructed based on these factors and successfully tested.The area under the receiver operating characteristic（ROC） curve was 0.761（95%C1：0.666-0.856） of the modeling group and 0.750（95% CI：0.577-0.923） of the validation group.Conclusions Upper abdominal operation history,diabetes mellitus,preoperative hemoglobin 〈 90 g/L and PPPD are associated with DGE after PD independently.The preoperative assessment of a patient＆#39;s prognostic for DGE after PD is feasible.The model is a valid tool to take precautions against DGE after PD.