不同胰管引流方式对胰十二指肠切除术后胰瘘的影响

Influence of different drainage modes of pancreatic duct on the incidence of pancreatic fistula after pancreaticoduodenectomy

目的:探讨不同胰管引流方式对胰十二指肠切除术(PD)术后胰瘘发生的影响。方法:回顾性分析第四军医大学附属第一医院西京医院2007年1月至2018年12月所有行PD的患者资料。共入组670例患者,其中男性415例,女性255例,年龄(58.4±7.3)岁,年龄范围24~82岁。按胰管引流方式的不同,进行倾向性评分匹配,分为内引流组(n=529)和外引流组(n=141)。比较两组胰瘘发生率。单因素和多因素logistic回归分析PD术后胰瘘影响因素。结果:内引流组胰瘘发生率12.5%(66/529),高于外引流组6.4%(9/141),差异有统计学意义(χ^(2)=4.16,P=0.041)。多因素logistic回归分析结果显示,年龄≥65岁(OR=2.004,95%CI:1.185~3.390)、合并消化道疾病(OR=3.087,95%CI:1.599~5.959)、有上腹部手术史(OR=2.031,95%CI:1.104~3.734)患者PD术后胰瘘风险升高(均P<0.05),外引流患者PD术后胰瘘风险降低(OR=0.470,95%CI:0.223~0.989,P=0.047),随着肿瘤最大径增加PD术后胰瘘风险降低(OR=0.725,95%CI:0.556~0.944,P=0.017),肿瘤位于胆总管PD术后胰瘘风险增加(OR=1.497,95%CI:1.192~1.880,P=0.001)。结论:与胰管内引流比较,胰管外引流在预防PD术后胰瘘发生方面具有显著优势。

Objective To investigate the effect of different drainage methods on pancreatic fistula after pancreaticoduodenectomy(PD).Methods The data of all patients with PD in Xijing Hospital,the First Affiliated Hospital of the Fourth Military Medical University from January 2007 to December 2018 were retrospectively analyzed.A total of 670 patients were enrolled,including 415 males and 255 females,aged(58.4±7.3)years,ranging from 24 to 82 years.According to the different method of pancreatic duct drainage,the propensity score was matched,and the patients were divided into internal drainage group(n=529)and external drainage group(n=141).The pancreatic fistula rate was compared between the two groups.Factors influencing pancreatic fistula after PD were analyzed by univariate and multivariate logistic regression.Results The incidence of pancreatic fistula in the internal drainage group was 12.5%(66/529),which was significantly higher than that in the external drainage group 6.4%(9/141)(χ^(2)=4.16,P=0.041).Multivariate logistic regression analysis showed that age≥65 years(OR=2.004,95%CI:1.185-3.390),complicated with digestive diseases(OR=3.087,95%CI:1.599-5.959),history of upper abdominal surgery(OR=2.031,95%CI:1.104-3.734)increased the risk of pancreatic fistula after PD(all P<0.05),decreased the risk of pancreatic fistula after PD in patients with external drainage(OR=0.470,95%CI:0.223-0.989,P=0.047),and decreased the risk of pancreatic fistula after PD with the tumor size(OR=0.725,95%CI:0.556-0.944,P=0.017),tumor located in the common bile duct after PD increased the risk of pancreatic fistula(OR=1.497,95%CI:1.192-1.880,P=0.001).Conclusions Compared with pancreatic duct drainage,external pancreatic duct drainage is better because of preventing postoperative pancreatic fistula.