腹腔镜胰十二指肠切除术围手术期并发症组织学相关危险因素分析

Analysis of risk factors for perioperative complications in laparoscopic pancreaticoduodenectomy

目的探索区域淋巴结清扫对腹腔镜胰十二指肠切除术围手术期并发症的影响。方法收集2017年1月-2022年12月兰州大学第一医院77例腹腔镜胰十二指肠切除术患者临床资料,包括患者基线资料、术中相关临床指标、术后病理检查结果、围手术期并发症,对可能影响围手术期并发症的相关危险因素进行分析。结果胰头后淋巴结清扫、手术时间≥450 min是术中出血量等级风险增加的独立危险因素;胰背侧下缘淋巴结清扫、胰头后淋巴结清扫数目是中转开腹发生的独立危险因素;十二指肠周围淋巴结清扫是B/C级胰瘘发生的独立危险因素;胰周淋巴结清扫是术后出血的独立保护因素,胃周淋巴清扫数目、腹腔感染是术后出血的独立危险因素;肿瘤直径是术后腹腔感染发生的独立保护因素,肠系膜上动脉周围淋巴结清扫数目、B/C级消化道排空障碍、术后出血是腹腔感染发生的独立危险因素;肝动脉旁淋巴结清扫、B/C级胰瘘是二次手术的独立危险因素;胃大弯淋巴结清扫、胆总管旁淋巴结清扫、经口进食时间、腹腔感染是B/C级消化道排空障碍发生的独立危险因素;术后出血是Clavien-Dind评分等级升高的独立危险因素。结论区域淋巴结清扫的深度与广度对腹腔镜胰十二指肠切除术围手术期并发症的发生有一定影响。

Objective To explore the impact of regional lymph node dissection on the perioperative complications in laparoscopic pancreaticoduodenectomy.Methods Clinical data of 77 patients undergoing laparoscopic pancreaticoduodenectomy in the First Hospital of Lanzhou University from January 2017 to December 2022 were collected,including baseline data,intraoperative relevant clinical indicators,postoperative pathological examination results,and perioperative complications.Relevant risk factors that might affect perioperative complications were analyzed.Results lymph node dissection and surgical time≥450 minutes were independent risk factors for increased intraoperative bleeding levels;the number of lymph node dissection at the dorsal lower margin and the posterior head of the pancreas were independent risk factors for the occurrence of conversion to open surgery;periduodenal lymph node dissection was an independent risk factor for the occurrence of B/C grade pancreatic fistula;peripancreatic lymph node dissection was an independent protective factor for postoperative bleeding,while the number of gastric lymph node dissection and abdominal infection were independent risk factors for postoperative bleeding;the diameter of the tumor was an independent protective factor for postoperative abdominal infection,while the number of lymph node dissections around the superior mesenteric artery,B/C grade gastrointestinal emptying obstruction,and postoperative bleeding were independent risk factors for abdominal infection;parahepatic lymph node dissection and B/C grade pancreatic fistula were independent risk factors for secondary surgery;gastric curvature lymph node dissection,common bile duct lymph node dissection,oral feeding time and abdominal infection were independent risk factors for the occurrence of B/C grade gastrointestinal emptying disorders;postoperative bleeding was an independent risk factor for increased Clavien Hind score.Conclusion The depth and breadth of regional lymph node dissection have a certain impact on the occurrence of perioperative complications in laparoscopic pancreaticoduodenectomy.