胰十二指肠切除术后胰瘘的危险因素及胰肠吻合方式分析

Risk Factors for Pancreatic Fistula after Pancreaticoduodenectomy and Choice of Pancreaticojejunostomy

目的探讨胰十二指肠切除术后胰瘘的危险因素及胰肠吻合方式的合理选择。方法选取本科室2016年3月至2017年12月118例接受胰十二指肠切除术患者,回顾性分析患者引起胰瘘的危险因素,并对2种常用胰肠吻合方式(端端套入式和端侧胰管对黏膜吻合)进行比较。结果 118例患者中胰瘘发生率32.2%(38/118),均为B级胰瘘。多因素回归分析显示胰腺质地和术中失血量为术后胰瘘发生的独立危险因素(P分别为0.047、0.001)。胰肠吻合方式比较显示端端套入式患者手术时间明显长于端侧胰管对黏膜吻合(P=0.026)。结论胰十二指肠切除术后胰腺质地软、术中失血量大的患者胰瘘发生率高。与端端套入式比较,端侧胰管对黏膜吻合可明显缩短手术时间。

Objective To investigate the risk factors for pancreatic fistula after pancreaticoduodenectomy and rational choice of pancreaticojejunostomy. Methods The study included 118 patients who underwent pancreaticoduodenectomy in the Hepatobiliary Surgery Department of the First Hospital of China Medical University between March 2016 and December 2017. The risk factors for pancreatic fistula were analyzed and a statistical comparison was performed between duct-to-mucosa and invagination pancreaticojejunostomy. Results The incidence of pancreatic fistula was 32.2%（38/118）,and all had B-grade fistulas. Multivariate logistic regression analysis revealed that soft pancreatic texture（P=0.047） and bleeding volume（P=0.001） were independent risk factors for pancreatic fistula. The operative time for the invagination group was longer than that for the duct-to-mucosa group（P=0.026）. Conclusion Soft pancreatic texture and increased bleeding volume predict a high probability of pancreatic fistula after pancreaticoduodenectomy. Duct-to-mucosa pancreaticojejunostomy can shorten the operative time.