492例胰十二指肠切除术后胃排空延迟的预后因素分析

Analysis of risk factors and outcomes for delayed gastric emptying following pancreaticoduodenectomy：a single center experience of 492 cases

目的探讨胰十二指肠切除（PD）术后发生胃排空延迟（CR－DGE）的预后因素。方法回顾性分析2012年1月至2014年12月在南京医科大学第一附属医院胰腺中心接受PD手术的492例患者资料。男性315例（64.0%），女性177例（36.0%），平均年龄60.5岁。采用单因素分析及多因素回归模型分析预后因素，筛选出与CR－DGE有关的独立预后因素。结果DGE的总体发生率为29.5%，其中与临床相关的B、C级DGE发生率分别为4.3%和5.9%。多因素回归模型分析结果显示，胰管直径〈3 mm（OR＝1.888，P＝0.042）、保留幽门胰十二指肠切除术（OR＝2.627，P＝0.005）和术后临床相关胰瘘（OR＝2.740，P＝0.007）是CR－DGE发生的独立预后因素。术后胰瘘严重程度、腹腔积液和腹腔感染与DGE的严重程度相关（χ2＝21.360、14.422、14.378，P＝0.011、0.002、0.002）。发生临床相关DGE患者的术后住院时间[31（24～41）d]和住院费用[（122 367.5±66 068.3）元]较无DGE患者[13（11～17）d、（78 200.7±27 043.9）元]明显增加，差异均有统计学意义（P值均〈0.01）。结论术中发现胰管直径细、施行保留幽门胰十二指肠切除术、术后出现胰瘘时，应警惕CR－DGE的发生，早期予以临床干预。

ObjectiveTo evaluate risk factors for delayed gastric emptying（DGE）following pancreaticoduodenectomy（PD）.MethodsThere were 492 consecutive patients who underwent PD in Pancreas Center, the First Affiliated Hospital with Nanjing Medical University between January 2012 and December 2014 were identified from a prospective database.There were 315 male and 177 female patients with a median age of 60.5 years.Univariate and multivariate analyses were performed to investigate the independent risk factors for clinically relevant DGE（CR-DGE）.ResultsThe overall incidence of DGE was 29.5%, with Grade B and C occurring at 4.3% and 5.9%, respectively.In multivariate analysis, pancreatic duct diameter less than 3 mm（OR=1.888, P=0.042）, pylorus-preserving pancreaticoduodenectomy（OR=2.627, P=0.005） and clinically relevant postoperative pancreatic fistula（OR=2.740, P=0.007） were independently associated with CR-DGE.Other main complications such as postoperative pancreatic fistula, pyoperitoneum, intraabdominal infection were also associated with the severity of DGE（χ2=21.360, 14.422, 14.378; P=0.011, 0.002, 0.002）. DGE patients had a significantly prolonged postoperative length of stay（31（24-41）d vs. 13（11-17）d） and increased medical cost（（122 367.5±66 068.3）yuan vs. （78 200.7±27 043.9）yuan）（both P〈0.01）.ConclusionsSmall pancreatic duct, underwent pylorus-preserving pancreaticoduodenectomy and suffered postoperative pancreatic fistula might indicate a high risk of CR-DGE.