腹腔镜胰十二指肠切除术后临床相关胃排空延迟危险因素分析

Analysis of risk factors for clinically relevant delayed gastric emptying after laparoscopic pancreaticoduodenectomy

目的分析腹腔镜胰十二指肠切除术(LPD)后发生临床相关胃排空延迟(CR-DGE)的危险因素。方法回顾性分析2014年7月至2019年12月华中科技大学同济医学院附属同济医院胆胰外科实施LPD的297例病人的临床资料。根据国际胰腺外科研究学组的标准定义,B级和C级胃排空延迟(DGE)被归类为CR-DGE。通过对围手术期临床相关及实验室指标作为独立变量进行单因素和多因素Logistic回归分析,评估LPD术后发生CRDGE的危险因素。结果297例病人中有71例(23.9%)术后发生CR-DGE,其中B级45例(15.2%),C级26例(8.7%)。单因素分析显示,术前高血清肌酐、术中出血量多、术后胰瘘(B、C级)、术后出血、腹腔感染、胰腺炎和Clavien-Dindo分级≥Ⅲ级是CR-DGE的危险因素(P<0.05)。多因素Logistic回归分析显示,术中出血量多(OR1.001,95%CI 1.000-1.003,P=0.0088)和腹腔感染(OR 8.017,95%CI 3.644-17.641,P<0.001)是CR-DGE的独立危险因素。结论术中出血量多和腹腔感染是LPD术后发生CR-DGE的独立危险因素,有效地降低术中出血和积极地控制术后腹腔感染有助于降低CR-DGE的发生率。

Objective To investigate the risk factors for clinically relevant delayed gastric emptying(CR-DGE)after laparoscopic pancreaticoduodenectomy(LPD).Methods The clinical data of 297 patients who underwent LPD in the Department of Biliary-Pancreatic Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from July 2014 to December 2019 were retrospectively reviewed.According to the standard definition of the International Study Group of Pancreatic Surgery(ISGPS),grades B and C of delayed gastric emptying(DGE)were classified as CR-DGE Univariate and multivariate Logistic regression analysis of independent variables in the perioperative period was used to assess the risk factors of CR-DGE in LPD patients.Results CR-DGE occurred in23.9%(71/297)of patients who underwent LPD,including 45 cases(15.2%)of grade B and 26 cases(8.7%)of grade C.Higher serum creatinine,more intraoperative blood loss,postoperative pancreatic fistula(grades B and C),postoperative hemorrhage,intra-abdominal infection,pancreatitis,and Clavien-Dindo≥Ⅲwere identified as risk factors for CR-DGE in the univariate analysis.Then,in the multivariate analysis,more intraoperative blood loss(OR 1.001,95%CI 1.000-1.003,P=0.0088)and intra-abdominal infection(OR 8.017,95%CI 3.644-17.641,P<0.001)were found to be independent risk factors affecting the incidence of CR-DGE.Conclusion For patients who underwent LPD,more intraoperative blood loss and intra-abdominal infection are independent risk factors for CR-DGE.Effectively reducing intraoperative bleeding and actively controlling postoperative intra-abdominal infection may effectively reduce the incidence of CR-DGE.