胰十二指肠切除术后并发症与预后的相关分析

Correlation analysis of complications and prognosis after pancreatoduodenectomy

目的分析壶腹部周围癌行胰十二指肠切除并发症的发生,探讨术后严重并发症与预后关系,同时结合临床资料分析影响总体生存率的独立危险因素。方法采用回顾性病例对照研究的方法。收集安徽医科大学第一附属医院肝胆胰外科2014年1月至2017年12月期间收治161例壶腹部周围癌行胰十二指肠切除术患者的临床资料。采用单因素和多因素分析的方法,确定影响总体生存率的独立危险因素。观察指标:(1)术后并发症情况;(2)随访结果;(3)影响总体生存率的因素。结果最终纳入完整随访资料113例。(1)术后并发症情况:其中术后胰瘘发生率为15.9%(18/113),严重并发症CD3-4级的发生率为12.4%(14/113)。(2)随访结果:中位随访时间为661天(30~1565 d),中位生存时间764天(613.47~914.53 d)。1年、2年、3年和4年总体生存率分别为79.6%、51.4%、30.6%和30.6%。(3)影响总体生存率的因素:单因素分析结果显示:肿瘤分化、年龄、肿瘤来源和术前总胆红素与总体生存率有关(χ^2=19.066,4.235,9.798,8.713,P<0.05)。并发症CD1~2级和CD 3~4级组的4年生存率分别为31.8%和35.7%(χ^2=3.417,P=0.065);胰瘘和非胰瘘组的4年生存率分别为33.5%和29.9%(χ^2=1.346,P=0.246),差异无统计学意义。多因素分析结果显示:肿瘤低分化(OR=2.274,95%CI=1.500~3.447,P=0.000)和肿瘤来源(OR=0.766,95%CI=0.602~0.976,P=0.031)是影响总体生存率的独立危险因素。结论胰十二指肠切除术后严重并发症发生率仍高达12.4%,而术后严重并发症和术后胰瘘与总体生存率无显著性关联。肿瘤低分化程度和肿瘤来源是影响总体生存率的独立危险因素。

Objective The complication of pancreatoduodenectomy for periampullary carcinoma was analyzed,and the relationship between severe postoperative complications and prognosis was analyzed.At the same time,independent risk factors affecting overall survival were analyzed with clinical data.Methods A retrospective case-control study was used.The clinical data of 161 patients with periampullary carcinoma undergoing pancreaticoduodenectomy were collected from the first affiliated hospital of Anhui Medical University from January 2014 to December 2017.Univariate analysis and multivariate analyses were used to identify independent risk factors that affected overall survival.Observation indicators:(1)postoperative complications;(2)follow-up results;(3)factors affecting overall survival.Results A total of 113 follow-up data were finally included.(1)Postoperative complications:the incidence of postoperative pancreatic fistula was 15.9%(18/113),and the incidence of severe complications CD3-4 was 12.4%(14/113).(2)Follow-up results:The median follow-up time was 661 days(30~1565 days),and the median survival time was 764 days(613.47~914.53 d).The overall survival rates at 1 year,2 years,3 years,and 4 years were 79.6%,51.4%,30.6%,and 30.6%,respectively.(3)Factors affecting overall survival:univariate analysis showed that tumor differentiation,age,tumor origin,and total bilirubin before surgery were related to overall survival(2=19.066,4.235,9.798,8.713,p<0.05).The 4-year survival rates in the CD1~2 and CD3~4 groups were 31.8%and 35.7%(χ^2=3.417,P=0.065);the 4-year survival rates in the pancreatic fistula and non-pancreatic fistula groups were 33.5,respectively.%And 29.9%(χ^2=1.346,P=0.246),the difference was not statistically significant.Multivariate analysis results showed that poorly differentiated tumors(OR=2.274,95%CI=1.500~3.447,P=0.000)and tumor origin(OR=0.766,95%CI=0.602~0.976,P=0.031)were affecting overall survival Independent risk factors.Conclusion The incidence of severe complications after pancreaticoduodenectomy was still as high as 12.4%,while the serious complications and postoperative pancreatic fistula were not significantly associated with overall survival.Poor tumor differentiation and tumor origin are independent risk factors that affect overall survival.