胃癌根治术后影响严重胰瘘发生的相关因素分析

Related factors affecting the occurrence of severe pancreatic fistula after radical gastrectomy

目的探讨胃癌根治术后影响严重胰瘘发生的相关因素。方法回顾性分析寿光市人民医院2015年1月至2021年1月行胃癌根治术患者460例的临床资料。依据术后是否发生严重胰瘘将患者分为严重胰瘘组(n=24例)与非严重胰瘘组(n=436例),比较两组患者的术前临床资料、手术资料及术后早期腹腔引流液淀粉酶水平。采用受试者工作特征(ROC)曲线计算预测胃癌术后严重胰瘘发生的第1、3天腹腔引流液淀粉酶水平的截断值,并比较不同淀粉酶分组的胰瘘发生率。采用多因素logistic回归分析影响术后严重胰瘘发生的独立危险因素。结果两组体质量指数、手术时间、术中出血量、术后第1天腹腔引流液淀粉酶、术后第3天腹腔引流液淀粉酶、脾切除例数差异均有统计学意义(均P<0.05)。术后预测严重胰瘘发生的第1、3天腹腔引流液淀粉酶浓度(D-AMY)截断值分别为2156 IU/L、596 IU/L,具有较高的灵敏度和特异度。胃癌术后第1、3天,高淀粉酶组胰瘘发生率为26.2%(16/61),明显高于低淀粉酶组的0.8%(3/334),差异有统计学意义(χ^(2)=62.82,P<0.05)。多因素logistic分析显示,肥胖,脾切除,胃癌术后第1、3天腹腔引流液淀粉酶高于截断值是影响严重胰瘘发生的独立危险因素,差异均有统计学意义(均P<0.05)。结论肥胖,脾切除,胃癌术后第1、3天腹腔引流液淀粉酶高于截断值是影响严重胰瘘发生的独立危险因素。术后第1天D-AMY>2156 IU/L和第3天D-AMY>596 IU/L可作为胃癌术后预测严重胰瘘发生的截断值。

Objective To investigate the related factors that affect the occurrence of severe pancreatic fistula after radical gastrectomy.Methods The clinical data of 460 patients undergoing radical gastrectomy in The People's Hospital of Shouguang from January 2015 to January 2021 were retrospectively analyzed.These patients were divided into severe pancreatic fistula group(n=24)and non-severe pancreatic fistula group(n=436)according to whether they developed severe pancreatic fistula after surgery.Preoperative clinical data,surgical data,and abdominal drainage fluid amylase level in the first postoperative days were compared.The receiver operating characteristics(ROC)curve was used to calculate the cutoff value of abdominal drainage fluid amylase level on the 1^(st) and 3^(rd) days of developing severe pancreatic fistula after radical gastrectomy.The incidence of pancreatic fistula was compared between different amylase level groups.Multivariate logistic regression was performed to analyze the independent risk factors of severe pancreatic fistula after surgery.Results There were significant differences in body mass index,operative time,intraoperative blood loss,peritoneal drainage fluid amylase level on the 1^(st) and 3^(rd) days after surgery,and the number of cases undergoing splenectomy between the two groups(all P<0.05).The cutoff values of amylase level in peritoneal drainage fluid(D-AMY)on the 1^(st) and 3^(rd) days after surgery were 2156 IU/L and 596 IU/L respectively,which had high sensitivity and specificity.On the 1^(st) and 3^(rd) days after surgery,the incidence of pancreatic fistula in the high-level amylase group was significantly higher than that in the low-level amylase group[26.2%(16/61)vs.0.8%(3/334),χ^(2)=62.82,P<0.05).Multivariate logistic analysis showed that obesity,splenectomy,and abdominal drainage fluid amylase level higher than the cut-off value on the 1^(st) and 3^(rd) days after surgery were independent risk factors for severe pancreatic fistula,and the differences were statistically significant(all P<0.05).Conclusion Obesity,splenectomy,and abdominal drainage fluid amylase level higher than the cut-off value on the 1^(st) and 3^(rd) days after surgery are independent risk factors affecting the occurrence of severe pancreatic fistula.D-AMY(>2156 IU/L)on the 1^(st) day and D-AMY(>596 IU/L)on the 3^(rd) day in the early postoperative days can be used as cutoff values to predict the occurrence of severe pancreatic fistula after radical gastrectomy.