胰十二指肠切除术后胰瘘的高危因素及胰体部平扫CT值对其预测价值的分析

High risk factors for pancreatic fistula after pancreaticoduodenectomy and predictive value of plain CT scanning in pancreatic body

目的探讨胰十二指肠切除术(pancreatoduodenectomy,PD)后胰瘘的高危因素及术前胰腺体部拟切除断面平扫期CT值(以下简称胰体部CT值)对PD术后胰瘘发生风险的预测价值。方法回顾性分析西南医院肝胆外科2013年1月至2015年12月期间收治的408例住院行胰十二指肠切除术患者的完整病历资料,单因素分析采用Pearson卡方检验,多因素分析采用二分类Logistic回归分析,胰体部CT值与胰瘘之间的相关性采用简单线性相关分析,其对PD术后胰瘘的预测价值采用受试者工作特征(ROC)曲线下面积。结果 408例患者共发生胰瘘123例(30.14%),单因素分析显示BMI、术前γ-谷氨酰转肽酶、胰管直径、胰体部CT值、手术时间、胰腺质地软硬(术中判断)是PD术后胰瘘的危险因素;多因素分析显示BMI≥25 kg/m^2、胰管直径≤3 mm、胰体部CT值<40 Hu、胰腺质地软(术中判断)软为PD术后胰瘘发生的独立高危因素。不同胰瘘严重程度分级患者的胰体部CT值相比较,差异有统计学意义(P<0.05)。胰瘘严重程度与胰体部CT值呈负相关。胰体部CT值ROC曲线下面积为0.714,对PD术后胰瘘具有中等预测价值。结论 BMI≥25 kg/m^2、胰管直径≤3 mm、胰体部CT值<40 Hu、胰腺质地软硬(术中判断)软为PD术后胰瘘发生的独立高危因素,胰体部CT值对PD术后胰瘘具有中等预测价值,可指导围手术期治疗方案。

Objective To investigate the high risk factors for pancreatic fistula after pancreaticoduodenectomy （PD） and the predictive value of p!ain CT scanning of the body of the pancreas. Methods Whole clinical data of 408 patients undergoing PD in our institute from January 2013 to December 2015 were collected and retrospectively analyzed. Univariate analysis using Pearson Chi-square test, multivariate analysis using binary logistic regression analysis to analyze the correlation between the values of CT scanning , and simple linear correlation analysis were used and pancreatic fistula. The predictive value of the CT values for pancreatic fistula after PD was analyzed by the receiver operating characteristic （ROC） curve. Results There were 123 cases （30. 14% ） of postoperative pancreatic fistula in 408 patients. Univariate analysis showed that body mass index （BMI）, preoperative gamma glutamyl transpeptidase, diameter of pancreatic duct, plain scanning CT values of pancreatic body, operation time, and texture of pancreas （judged intraoperatively） were risk factors for pancreatic fistula after PD. Multivariate analysis showed that BMI ≥ 25 kg/m2, pancreatic duct diameter ≤ 3 mm, CT value of pancreatic body 〈 40 Hu, and soft texture were independent high risk factors for pancreatic fistula after PD. There were significant differences in CT values of pancreatic body in The patients with different severity of pancreatic fistula （ P 〈 0.05 ）. The severity was negatively correlated with the CT value of pancreatic body. The area under ROC for the CT value of pancreatic body was 0.714, indicating a moderate predictive value for pancreatic fistula after PD. Conclusion BMI ≥ 25 kg,/m2, pancreatic duct diameter ≤ 3 mm, plain scanning CT value of pancreatic body 〈 40 Hu, intraoperative soft texture of pancreas are independent high risk factors for pancreatic fistula after PD. The CT value is of moderate predictive value for the fistula, and can used to guide the perioperative treatment regimen.