腹腔镜胃癌根治术后胰瘘发生率及其影响因素

Incidence and risk factors of postoperative pancreatic fistula after radical laparoscopic gastrectomy

目的探讨腹腔镜胃癌根治术后胰瘘的发生率及其影响因素。方法回顾性分析上海交通大学医学院附属瑞金医院普通外科2018年1月至2020年11月完成的290例腹腔镜胃癌根治术病人的各级胰瘘发生率,对病人一般临床病理信息和术中、术后资料进行统计,分析胰瘘发生的影响因素。结果腹腔镜胃癌根治术后,胰瘘总发生率为22.8%(66/290),其中生化瘘发生率为21.4%(62/290),B级胰瘘发生率为1.4%(4/290),无C级胰瘘病例。分析提示B级胰瘘组病例的体质量指数(BMI)显著高于无胰瘘及生化瘘组病例[(28.7±1.0)kg/m^(2)、(23.1±3.3)kg/m^(2)、(23.1±2.9)kg/m^(2),P<0.05];B级胰瘘组病例的新辅助化疗比例显著高于无胰瘘及生化瘘组病例(75.0%、9.8%、3.2%,P<0.05);B级胰瘘组病例的腹部手术史比例显著高于无胰瘘及生化瘘组病例(75.0%、23.2%、21.0%,P<0.05);B级胰瘘组病例的清扫淋巴结阳性数显著高于无胰瘘及生化瘘组病例[(13.7±9.2)枚、(4.9±7.6)枚、(5.1±7.2)枚,P<0.05];B级胰瘘组病例的手术时间显著高于无胰瘘及生化瘘组病例[(280.0±21.6)min、(195.3±47.9)min、(201.9±44.7)min,P<0.05]。结论腹腔镜胃癌根治术后B级、C级胰瘘发生率低,对BMI高、有腹部手术史、有新辅助化疗史、阳性淋巴结数目多和手术时间长的病例,应警惕B级胰瘘的发生。

Objective To explore the incidence and risk factors of postoperative pancreatic fistula(POPF)after radical laparoscopic gastrectomy.Methods The incidence of pancreatic fistula was retrospectively analyzed for 290 patients undergoing radical laparoscopic gastrectomy from January 2018 to November 2020.General profiles and operative pathological data were reviewed and the risk factors of pancreatic fistula analyzed.Also the predictive significance of postoperative drainage amylase measurement was examined for such postoperative complications as pancreatic fistula and duodenum stump leakage.Results The incidence of POPF after radical laparoscopic gastrectomy is:the total incidence of POPF is 22.8%(66/290),biological pancreatic fistula is 21.4%(62/290),grade B pancreatic fistula is 1.4%(4/290),and no grade C pancreatic fistula occurred.Analysis shows thatbody mass index(BMI)in grade B POPF group is significantly higher than non-pancreatic fistula group and bioleak(BL)group[(28.7±1.0)kg/m^(2) vs.(23.1±3.3)kg/m^(2) vs.(23.1±2.9)kg/m^(2),P<0.05].Ratio of neoadjuvant therapy in grade B POPF group is significantly higher than non-pancreatic fistula group and BL group(75.0%vs.9.8%vs.3.2%,P<0.05).Ratio of abdominal surgery history in grade B POPF group is significantly higher than non-pancreatic fistula group and BL group(75.0%vs.23.2%vs.21.0%,P<0.05).Positive lymph nodes dissectionin grade B POPF group is significantly higher than non-pancreatic fistula group and BL group(13.7±9.2 vs.4.9±7.6 vs.5.1±7.2,P<0.05).Time of surgeryin grade B POPF group is significantly higher than non-pancreatic fistula group and BL group[(280.0±21.6)min、(195.3±47.9)min、(201.9±44.7)min,P<0.05].Conclusion The incidence of grade B/C POPF is low after radical laparoscopic gastrectomy.Occurrence of grade B POPF should be concerned about if cases exist high BMI,neoadjuvant therapy,abdominal surgery history,high positive lymph nodes dissection,prolonged time of surgery.