腹腔镜辅助远端胃癌根治术后胰瘘的相关影响因素分析

Analysis of related factors of pancreatic fistula after laparoscopic-assisted radical resection of distalgastric cancer

目的探讨腹腔镜辅助远端胃癌根治术(LADG)后胰瘘发生的相关影响因素。方法回顾性分析2017年6月—2018年3月于首都医科大学附属北京友谊医院行LADG的患者189例,从中筛选符合术后胰瘘诊断标准的27例患者纳人胰瘘组,再随机选择同期的未发生胰痿患者27例纳入非胰瘘组,记录所有患者的术前特征和手术数据,包括体重指数、内脏脂肪面积、术前病史、肿瘤分期、手术时间及出血量等,分析术后胰瘘发生的相关影响因素。计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料组间比较采用χ^2检验。结果﹐高体重指数(t=3.956,P=0.003),高内脏脂肪面积(t=6.161,P=0.038),手术时间长(t=2.650,P=0.024),出血量大(t=1.887,P=0.042),淋巴结清扫范围广(t=2.092,P=0.001)的患者更易出现术后胰瘘,而内脏脂肪面积/腹部总脂肪面积比值(=1.334,P=0.324),术前合并肺疾病(χ^2=0.750,P=0.379),冠心病(χ^2=0.081,P=0.500),高血压(χ^2=0.667,P=0.239),糖尿病(χ^2=2.030,P=0.127),慢性肾脏病(χ^2=0.587,P=0.352),肿瘤分期(χ^2=1.388,P=0.500)等因素组间比较差异无统计学意义。结论肥胖患者及手术时间长的LAIDG患者发生术后胰瘘的可能性更大,综合性术前判断及谨慎的术中操作可能是避免术后胰瘘发生的有效手段之一。

Objective To investigate the related factors of pancreatic fistula after laparoscopic-assisteddistal gastrectomy(LADG).Methods A retrospective analysis was performed of 189 patients who underwent LADG in Beijing Friendship Hospital,Capital Medical University from June 2017 to March 2018.Tiwenty-sevenpatients with postoperative pancreatic fistula and 27 randomly selected normal patients were included in the study.The preoperative characteristics and surgical data of al patients were recordedl,including bodly mass index,visceralfat area,past history,preoperative turmor staging,operation time and bleeding volume,etc.The related factors ofpostoperative pancreatic fistula were analyzedl.Measurement data were expressed as mean±standard deviation(Mean±SD),and t-test was used for comparison between groups.Chi-square test was used to compare the countdata between groups.Results The patients with high body mass index(t=3.956,P=0.003),high visceral fatarea(t=6.16l,P=0.038),long operation time(t=2.650,P=0.024),profuse hemorrhage(t=1.887,P=0.042),complete lymphadenectomy(t=2.092,P=0.001)were prone to postoperative pancreatic fistula,whilethere was no significant difference of visceral fat area/total abdominal fat area(χ^2=1.334,P=0.324),preoperative with pulmonary diseases(χ^2=0.750,P=0.379),coronary heart disease(χ^2=0.081,P=0.500),hypertension(χ^2=0.667,P=0.239),dlialbetes mellitus(χ^2=2.030,P=0.127),chronic kidney disease(χ^2=0.587,P=0.352),tumor stage(χ^2=1.388,P=0.500)and other factors hetween the two groups.Conclusions Obesity patients and LADG patients with long operation time are more likely to have postoperative pancreatic fistula.Comprehensive preoperative assessment and prudent intraoperative operation may be one of the effective methodls to avoid postoperative pancreatic fistula.