胰体尾切除术后胰瘘的影响因素分析

Influencing factors on pancreatic fistula rates after distal pancreatectomy

目的探讨胰体尾切除术后胰瘘发生的影响因素,为临床预防术后胰瘘提供依据。方法回顾性分析2011年3月至2018年4月在中国医科大学附属第一医院行胰体尾切除术的281例患者的临床资料,其中男性89例,女性192例,年龄(51.01±13.65)岁。对可能影响术后胰瘘发生的性别、年龄、体质量指数(BMI)、肿瘤特点、术前空腹血糖、血生化、肝功能和手术指标等进行单因素和多因素logistic回归分析。结果281例行胰体尾切除的患者中无胰瘘/生化漏245例(87.2%),有临床意义的胰瘘(B/C级)36例(12.8%)。单因素分析结果显示,影响术后胰瘘发生的因素有BMI、术前空腹血糖、是否结扎主胰管(均P<0.05)。多因素logistic回归分析结果显示,影响术后胰瘘发生的独立危险因素为BMI≥25 kg/m^(2)(OR=2.354,95%CI:1.137~4.873,P<0.05)、未结扎主胰管(OR=4.067,95%CI:1.191~13.885,P<0.05)。结论BMI较高者可增加术后胰瘘发生的风险,手术过程中结扎主胰管可减少术后胰瘘的发生。

Objective To study factors influencing postoperative pancreatic fistula rates with a view to prevent postoperation pancreatic fistula from happening.Methods This is a retrospective study on 281 patients who underwent distal pancreatectomy at the First Affiliated Hospital of China Medical University from March 2011 to April 2018.There were 89 males and 192 females,with the age of(51.01±13.65)years.Univariate and multivariate logistic regression analyses were used to analyze the following factors on the occurrence of pancreatic fistula after operation:gender,age,body mass index(BMI),tumor characteristics,preoperative fasting blood glucose,blood biochemistry,liver function and surgical indications.Results Of the 281 patients who underwent distal pancreatectomy in this study,245(87.2%)did not develop pancreatic fistula/biochemical leakage,while 36(12.8%)patients developed clinically significant pancreatic fistula(B/C grade).Univariate analysis showed the factors which affected the incidence of pancreatic fistula after surgery to include:BMI,preoperative fasting blood glucose,and whether the main pancreatic duct was ligated(all P<0.05).Multivariate logistic regression analysis showed that the independent factors affecting pancreatic fistula incidence after surgery were BMI≥25 kg/m^(2)(OR=2.354,95%CI:1.137-4.873,P<0.05),and main pancreatic duct was not ligated(OR=4.067,95%CI:1.191-13.885,P<0.05).Conclusions A high BMI increased the risk of postoperative pancreatic fistula,while ligation of main pancreatic duct during surgery reduced the risk.