远端胰腺切除术后发生胰瘘的危险因素分析

Risk factors of pancreatic fistula after distal pancreatectomy

目的探讨远端胰腺切除术(distal pancreatectomy,DP)后发生术后胰瘘(postoperative pancreaticfistula,POPF)的危险因素。方法回顾性分析2014 年1 月至2018 年10 月在西南医科大学附属医院肝胆外科接受诊治的81 例胰腺远端肿瘤性病变行DP的临床资料,对可能导致POPF的相关因素进行单因素分析和Logistic回归分析。结果 81例患者DP术后发生生化漏13 例,B级胰瘘9 例,C级胰瘘3 例。单因素分析显示POPF可能与手术时间、术中失血量及内脏脂肪面积有关(P<0.05);Logistic回归分析显示,手术时间(OR 1.060,95%CI 1.021~1.102,P=0.003)及内脏脂肪面积(OR 1.116,95%CI 1.046~1.190,P=0.001)是POPF的独立危险因素。结论手术时间和内脏脂肪面积是DP术后发生临床胰瘘的独立危险因素。对内脏脂肪面积较大的患者需采取积极预防措施。

Objective To analyze the risk factors of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP). Methods The clinical data of 81 patients with distal pancreatic neoplastic lesions who underwent DP in Affiliated Hospital of Southwest Medical University from Jan. 2014 to Oct. 2018 were retrospectively analyzed. And the related factors that may lead to POPF were analyzed by univariate analysis and Logistic regression analysis. Results Among the 81 patients, postoperative pancreatic fistula occurred in 25 cases, biochemical leakage in 13 cases, grade B pancreatic leakage in 9 cases and grade C pancreatic leakage in 3 cases. Univariate analysis showed that POPF may be related to operation time, intraoperative blood loss and visceral fat area (P<0.05). Logistic regression analysis showed that operation time (OR 1.060 95%CI 1.021~1.102, P=0.003) and visceral fat area (OR 1.116, 95%CI 1.046~1.190, P=0.001) were independent risk factors for POPF. Conclusion Operative time and visceral fat area are independent risk factors for clinically significant postoperative pancreatic fistula. Active preventive measures should be taken for patients with large visceral fat area.