胰十二指肠切除术后胰瘘发生的危险因素分析

Risk factors analysis of pancreatic fistula after pancreaticoduodenectomy

目的探讨胰十二指肠切除术后胰瘘发生的危险因素。方法采用回顾性病例对照研究方法。收集2011年1月至2015年12月中山大学附属第一医院收治的310例行胰十二指肠切除术患者的临床病理资料。观察指标：（1）随访情况。（2）影响胰十二指肠切除术后胰瘘发生的危险因素分析。采用门诊和电话方式进行随访．了解患者胰十二指肠切除术后胰瘘发生情况及有无因胰瘘引起的二次住院或死亡情况。随访时间截至2016年6月。单因素分析采用驴检验，多冈素分析采用Logistic回归模型。结果（1）随访情况：310例患者均获得随访，随访时问为6～60个月，巾位随访时间为31个月。随访期间，65例患者发生胰瘘，包括B级胰瘘59例，c级胰瘘6例。其中24例接受保守治疗，4l例接受B超引导下置管引流术。63例患者经治疗后好转，痊愈出院：2例c级胰瘘患者[大I胰瘘相关并发症死亡。（2）影响胰十二指肠切除术后胰瘘发生的危险因素分析。单岗素分析结果显示：合并高血压病、术者行胰十二指肠切除术例数、手术时间及胰肠吻合方式是影响胰十二指肠切除术后胰瘘发生的相关冈素（X^2=5．986，13．006，9．025，21．561，P〈O．05）。多冈素分析结果显示：合并高血压病、手术时间〉6h、胰肠吻合方式为端端胰肠套人式吻合或捆绑式胰肠吻合是影响胰十二指肠切除术后胰瘘发生的独立危险因素（优势比=2．465．1．880，2．719，6．190，95％可信区间：1．253．4．850，1．025～3．448，1．254～5．894，2．309～16．592，P〈0．05），，结论合并高血压病、手术时间〉6h、胰肠吻合方式为端端胰肠套人式吻合或捆绑式胰肠吻合是影响胰十二指肠切除术后胰瘘发生的独立危险因素。

Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy. Methods The retrospective case-control study was conducted. The clinicopathological data of 310 patients who underwent panereaticoduodenectomy in the First Affiliated Hospital of Sun Yat-Sen University between January 2011 and December 2015 were collected. Observation indicators： （1） follow-up situations; （2） risk factors analysis of pancreatic fistula after pancreaticoduodenectomy. Follow-up using outpatient examination and telephone interview was performed to detect occurrence of pancreatic： fistula and pancreatic fistula-induced rehospitalization or death up to June 2016. The univariate and multivariale analyses were respectively done using the chi-square test and logistic regression model. Results （ 1 ） Follow-up situations ： 310 patients were followed up for 6-60 months, with a median time of 31 months. During the follow-up, 65 patients were complicated with pancreatic fistula, including 59 in grade B and 6 in grade C. Twenty-four patients received conservative treatment, and 41 received B ultrasound-guided catheter drainage. Of 65 patients, 63 were improved and then discharged form hospital; 2 in grade C of pancreatic fistula died of pancreatic fistula-related complications. （2） Risk factors analysis of pancreatic fistula after pancreatieoduodenectomy： univariate analysis showed that combined hypertension, cases with pancreatieoduodenectomy, operation time and pancreatieojejunostomy method were related factors affecting pancreatic fistula after pancreatieoduodeneetomy （X^2= 5. 986, 13. 006, 9. 025, 21. 561, P〈0. 05）. The multivariate analysis showed that combined hypertension, operation time 〉 6 hours and end-to-end telescopic pancreatico- jejunostomy or binding pancreaticojejunostomy were independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy （Odds ratio=2. 465, 1. 880, 2. 719, 6. 190, 95% confidence interval： 1. 253-4. 850, 1. 025-3. 448, 1. 254-5. 894, 2. 309-16. 592, P〈0. 05）. Conclusion The combined hypertension, operation time 〉 6 hours and end-to-end telescopic panereatieojejunostomy or binding pancreatieojejunostomy are independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy.