保留十二指肠、胆总管、Oddi括约肌的胰头整块全切除术后并发症分析

Analysis of complications after duodenum,common bile duct and sphincter of Oddi-preserving pancreatic head total resection

目的:探讨保留十二指肠、胆总管、Oddi括约肌的胰头整块全切除术(DCOPPHTR)术后并发症发生情况及其影响因素。方法:回顾性分析2020年6月至2022年11月在重庆市人民医院行DCOPPHTR的32例胰腺肿瘤患者临床资料。其中男19例,女13例;平均年龄(44±16)岁。患者均签署知情同意书,符合医学伦理学规定。根据有无术后并发症分为并发症组(12例)与无并发症组(20例),分析术后并发症发生的影响因素;同时检索保留十二指肠胰头切除术相关文献,分析术后并发症发生率。并发症影响因素分析采用Logistic多因素回归分析。结果:患者均顺利完成手术。手术时间(469±81)min,术中出血量(195±120)ml。术后发生并发症12例,其中胰瘘6例,胆漏1例,术后出血2例,腹腔感染2例,胃排空障碍1例。根据并发症Clavien-Dindo系统分级,Ⅰ级7例,Ⅱ级1例,Ⅲa级4例,无Ⅲb、Ⅳ、Ⅴ级并发症。并发症组术前主胰管直径(6±3)mm,明显小于无并发症组的(9±4)mm(t=-2.070,P<0.05);住院时间为(31±10)d,明显长于无并发症组的(17±5)d(t=4.551,P<0.05)。Logistic多因素回归分析提示术前主胰管直径(OR=0.74,95%CI:0.56~0.99)、手术时间(OR=1.01,95%CI:1.00~1.03)是胰腺肿瘤患者DCOPPHTR术后并发症发生的独立影响因素(P<0.05)。结论:DCOPPHTR是治疗胰头部炎性肿块及良性或低度恶性肿瘤的理想手术方式,术前主胰管直径、手术时间是胰腺肿瘤患者DCOPPHTR术后并发症发生的独立影响因素。

Objective To investigate the incidence of postoperative complications and influencing factors after duodenum,common bile duct and sphincter of Oddi-preserving pancreatic head total resection(DCOPPHTR).Methods Clinical data of 32 patients with pancreatic tumors who underwent DCOPPHTR in Chongqing General Hospital from June 2020 to November 2022 were retrospectively analyzed.Among them,19 patients were male and 13 female,aged(44±16)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.According to the incidence of postoperative complications,all patients were divided into the complication(n=12)and non-complication groups(n=20).The influencing factors of postoperative complications were analyzed.Studies related to DCOPPHTR were retrieved.The incidence of postoperative complications was analyzed.The risk factors of complications were identified by multivariate Logistic regression analysis.Results All patients successfully completed DCOPPHTR.The operation time was(469±81)min,and intraoperative blood loss was(195±120)ml.Postoperative complications occurred in 12 patients,including pancreatic fistula in 6,bile leakage in 1,postoperative bleeding in 2,abdominal infection in 2 and delayed gastric emptying in 1,respectively.According to Clavien-Dindo classification system,7 patients developed gradeⅠcomplications,1 case of gradeⅡand 4 cases of gradeⅢa.No gradeⅢb,ⅣandⅤcomplications were reported.In the complication group,preoperative diameter of main pancreatic duct was(6±3)mm,significantly shorter than(9±4)mm in thenon-complication group(t=-2.070,P<0.05).In the complication group,the length of hospital stay was(31±10)d,significantly longer than(17±5)d in the non-complication group(t=4.551,P<0.05).Multivariate Logistic regression analysis indicated that preoperative diameter of main pancreatic duct(OR=0.74,95%CI:0.56-0.99)and operation time(OR=1.01,95%CI:1.00-1.03)were the independent influencing factors for postoperative complications of DCOPPHTR in patients with pancreatic tumors(P<0.05).Conclusions DCOPPHTR is an ideal surgical treatment for inflammatory masses and benign or low-grade malignant tumors in pancreatic head.Preoperative diameter of main pancreatic duct and operation time are the independent influencing factors for postoperative complications of DCOPPTR in patients with pancreatic tumors.