PD贯穿式胰肠吻合术后胰瘘相关危险因素分析

Risk factors of pancreatic fistula after pancreaticoduodenectomy and pancreaticojejunostomy

目的分析胰十二指肠切除术(PD)贯穿式胰肠吻合(PPJ)临床相关性术后胰瘘(CR-POPF)发生的相关危险因素。方法回顾性分析2017年1月至2022年10月在皖南医学院第一附属医院肝胆外科行PD且术中采用PPJ的108例患者临床资料,其中男性65例,女性43例,年龄65.5(54.2,72.0)岁。观察患者术后胰瘘、胆瘘、腹腔出血等相关并发症,对CR-POPF的相关因素进行单因素分析,将P<0.10的因素纳入logistic多因素回归分析。结果108例患者均成功行PD治疗,其中腹腔镜PD患者76例(70.4%),开腹PD患者32例(29.6%)。术中均采用了PPJ,包括贯穿式胰肠连续吻合39例(36.1%)、贯穿式胰肠间断吻合49例(45.4%)和改良贯穿式胰肠连续吻合20例(18.5%)。手术时间390.0(314.0,480.0)min,术中出血量200.0(100.0,384.0)ml,术后住院时间为12.0(10.0,15.0)d,术后胰瘘(B+C级)发生率为11.1%(12/108)。年龄、体质量指数、胰腺CT值、胰管粗细是发生CR-POPF的影响因素(均P<0.05)。多因素logistic回归分析显示,年龄(OR=0.895,95%CI:0.822~0.975)、胰腺CT值(OR=0.812,95%CI:0.698~0.946)、胰管直径(OR=0.457,95%CI:0.220~0.952)是PPJ术后胰瘘的危险因素(均P<0.05)。结论PPJ是一种安全的胰肠吻合方式,其术后胰瘘可能与年龄偏小、胰腺CT值偏低和胰管直径较细有关,仍需扩大数据进一步验证。

Objective To analyze the risk factors of clinically-relevant postoperative pancreatic fistula(CR-POPF)after pancreaticoduodenectomy(PD)and penetrating pancreaticojejunostomy(PPJ).Methods The clinical data of 108 patients who underwent PD and PPJ in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Wannan Medical College from January 2017 to October 2022 were analyzed retrospectively,including 65 males and 43 females,aged 65.5(54.2,72.0)years.The incidences of POPF,biliary fistula,abdominal bleeding and other related complications were reviewed.The related factors of CR-POPF were analyzed by univariate analysis,and the statistically significant factors were included in multivariate logistic regression analysis.Results A total of 108 patients were successfully treated with PD,including laparoscopic PD in 76 cases(70.4%)and open PD in 32 cases(29.6%).PPJ was performed in PD,including the continuous fashion in 39 cases(36.1%),intermittent fashion in 49 cases(45.4%)and modified continuous fashion in 20 cases(18.5%).The operation time was 390.0(314.0,480.0)min,the intraoperative blood loss was 200.0(100.0,384.0)ml,the postoperative hospital stay was 12.0(10.0,15.0)d,and the incidence of POPF(grade B+C)was 11.1%(12/108).Body mass index,pancreatic CT value and pancreatic duct size were the significant factors of CR-POPF(all P<0.05).Multivariate logistic regression analysis showed that age(OR=0.895,95%CI:0.822-0.975),pancreatic CT value(OR=0.812,95%CI:0.698-0.946)and pancreatic duct size(OR=0.457,95%CI:0.220-0.952)were risk factors of CR-POPF after PPJ(all P<0.05).Conclusion PPJ is a safe method of pancreaticoenterostomy,and CR-POPF may be related to younger patients,lower pancreatic CT value and the smaller pancreatic duct size.