壶腹癌行胰十二指肠切除术后胰瘘的危险因素分析

Risk factor analysis for pancreatic fistula after pancreaticoduodenectomy for Vater′s ampullary carcinoma

目的探讨壶腹癌患者行胰十二指肠切除术(PD)后发生临床相关性胰瘘的危险因素。方法回顾性分析2018年1月至2020年12月间南京大学医学院附属鼓楼医院肝胆胰中心收治的93例因壶腹癌行PD患者的临床资料,根据术后有无发生临床相关性胰瘘分为胰瘘组和非胰瘘组。对围术期可能影响术后胰瘘发生的相关因素进行单因素分析以及多因素logistic回归分析,明确壶腹癌患者PD后出现胰瘘的独立危险因素。结果共44例壶腹癌患者PD后出现胰瘘,胰瘘发生率为47.3%(44/93)。术后腹腔引流液培养中最多见的病原菌依次是肺炎克雷伯杆菌(25.8%)、粪肠球菌(19.4%)、阴沟肠杆菌(11.8%)、屎肠球菌(10.7%)。单因素分析结果显示,胰瘘组的手术时间、术后第1天血CRP水平及术后腹腔引流液中的肺炎克雷伯杆菌、粪肠球菌、屎肠球菌与非胰瘘组比较差异均有统计学意义(P值均<0.05);多因素分析结果显示,术后第1天血CRP水平(OR1.029,95%CI1.003~1.055,P=0.026),术后腹腔引流液检出肺炎克雷伯杆菌(OR8.671,95%CI2.366~31.772,P=0.001)、粪肠球菌(OR10.497,95%CI2.306~41.776,P=0.002)、屎肠球菌(OR22.580,95%CI2.303~221.403,P=0.007)是壶腹癌患者PD后发生胰瘘的独立危险因素。结论壶腹癌患者行PD后发生临床相关性胰瘘的独立危险因素为术后第1天血CRP水平及术后腹腔引流液培养检测出肺炎克雷伯杆菌、粪肠球菌、屎肠球菌。

Objective To identify the risk factors of clinically relevant pancreatic fistula(CR-POPF)after pancreaticoduodenectomy(PD)for Vater′s ampullary carcinoma.Methods The clinical data of 93 Vater's ampullary carcinoma patients who had undergone PD in Nanjing Drum Tower Hospital from January 2018 to December 2020 was retrospectively analyzed.According to the occurrence of CR-POPF,all patients were divided into the CR-POPF group and no CR-POPF group.Univariate analysis and multivariate analysis by logistic regression model were performed for perioperative risk factors of CR-POPF to identify the independent risk factors for CR-POPF after PD for Vater's ampullary carcinoma.Results 44 patients developed CR-POPF and the rate of CR-POPF was 47.3%(44/93).The most frequently detected microorganisms from abdominal drain fluid after operation were Klebsiella pneumoniae(25.8%),Enterococcus faecalis(19.4%),Enterobacter cloacae(11.8%)and Enterococcus faecium(10.7%).The results of univariate analysis showed that operation time,C-reactive protein(CRP)on postoperative day(POD)1,Klebsiella pneumoniae,Enterococcus faecalis and Enterococcus faecium in the abdominal drainage were statistically different between the two groups(all P value<0.05).Multivariate analysis revealed that CRP on POD1(OR 1.029,95%CI 1.003-1.055,P=0.026),Klebsiella pneumoniae(OR 8.671,95%CI 2.366-31.772,P=0.001),Enterococcus faecalis(OR 10.497,95%CI 2.306-41.776,P=0.002)and Enterococcus faecium(OR 22.580,95%CI 2.303-221.403,P=0.007)in the abdominal drainage were independent risk factors for the development of CR-POPF after PD for Vater′s ampullary carcinoma.Conclusions CRP on POD1,Klebsiella pneumoniae,Enterococcus faecalis and Enterococcus faecium in the drain samples were independent risk factors for the development of CR-POPF after PD for Vater′s ampullary carcinoma.