切割缝合器钉仓及胰腺厚度对胰体尾切除术后胰瘘的影响

Effect of Cutting Stapler Staple and Pancreatic Thickness on Pancreatic Fistula after Pancreatic Body and Tail Resection

目的对胰体尾切除术(DP)相关临床资料进行总结,并对术后胰瘘发生的危险因素进行分析。方法回顾性分析2011年1月—2016年12月该院应用切割缝合器(GIA)施行胰体尾切除术的65例患者临床资料。结果 65例患者术后并发症发生率44.6%(29/65),无住院期间死亡。胰瘘发生率15.4%(10/65,其中B级8例,C级2例);单因素Logistic分析示断面喷洒生物胶(P=0.061)、胰腺预切线厚度(P=0.001)及GIA钉仓(P=0.015)与胰瘘发生相关。采用二元Logistic回归模型进行多因素分析,结果显示胰腺预切线厚度(P=0.002,OR=1.854)及GIA钉仓选择蓝钉(P=0.015,OR=42.36)为胰瘘发生的独立危险因素;胰腺预切线与胰瘘之间的ROC曲线图分析可知,曲线下面积(AUC)为0.869(P=0.001),胰腺预切线厚度取15.7 mm分界值时,约登指数最大(0.627),对胰瘘的预测敏感度为90.0%,特异度为72.7%,阳性预测值为37.5%,阴性预测值为97.6%。胰腺预切线厚度>15.7 mm对比胰腺预切线厚度<15.7 mm有着更高的胰瘘发生率(37.5%vs 2.4%,P=0.001,OR=24.00)。胰腺预切线>15.7 mm中蓝钉对比白钉亦有着更高的胰瘘率(85.7%vs 17.6%,P=0.002,OR=28.00)。结论胰腺预切线厚度及GIA钉仓选择蓝钉为胰瘘发生的独立危险因素。GIA钉仓选用蓝钉可增加DP术后胰瘘发生率,对厚的胰腺GIA钉仓选用白钉或许更加适合。

Objective To summarize the clinical data of pancreatic body and tail resection(DP) and analyze the risk factors of postoperative pancreatic fistula.Methods The clinical data of 65 patients who underwent pancreatic body and tail resection with a cutting stapler(GIA) from January 2011 to December 2016 were retrospectively analyzed.Results The postoperative complication rate of the 65 patients was 44.6%(29/65),and there was no death during hospitalization.The incidence of pancreatic fistula was 15.4%(10/65,including 8 cases of grade B and 2 cases of grade C).One-way logistic analysis showed that the bio-adhesive(P=0.061),pancreatic pre-tangential thickness(P=0.001) and GIA nails were used.The bin(P =0.015) was associated with pancreatic fistula.Multivariate analysis using binary logistic regression model showed that pancreatic pre-tangential thickness(P=0.002,OR=1.854) and GIA staple selection blue nail(P=0.015,OR=42.36) were independent risk factors for pancreatic fistula.The ROC curve analysis between the pancreatic pre-tangent line and the pancreatic fistula showed that the area under the curve(AUC) was 0.869(P=0.001),and the approximate index of the pancreat ic pre-tangential line was 15.7 mm,(0.627),the predictive sensitivity to pancreatic fistula was 90.0%,the specificity was72.7%,the positive predictive value was 37.5%,and the negative predictive value was 97.6%.Pancreatic pre-tangential thickness >15.7 mm vs.pancreatic pre-tangential thickness <15.7 mm had a higher incidence of pancreatic fistula(37.5%vs 2.4%,P=0.001,OR=24.00).The pancreas pre-cut line >15.7 mm medium blue nail has a higher pancreatic rate than the white nail(85.7% vs 17.6%,P=0.002,OR=28.00).Conclusion Pancreatic pre-tangential thickness and selection of blue nails in GIA staples are independent risk factors for pancreatic fistula.The use of blue nails in GIA staples can increase the incidence of pancreatic fistula after DP.It may be more appropriate to use white nails for thick pancreatic GIA staple cartridges.