影响壶腹周围癌胰十二指肠切除术后“教科书式结局”的危险因素分析

Analysis of risk factors affecting“textbook outcome”after pancreatoduodenectomy for periampullary cancer

目的分析影响壶腹周围癌胰十二指肠切除术后达到“教科书式结局”(textcome book,TO)的危险因素。方法回顾性分析2017年12月至2021年12月昆明医科大学第二附属医院收治的134例壶腹周围癌行胰十二指肠切除术病人的临床病理资料,选取22个临床因素,首先单因素分析筛选出临床因素与TO之间的相关性,再采用logistic回归分析筛选出与TO相关的独立危险因素。结果134例病人中43例(32.0%)达到TO,91例(67.9%)未达到TO。单因素分析结果显示:性别、手术出血量>525 mL、手术方式、术前胆道引流、术前无症状白细胞增高、术前总胆红素>22μmol/L、术前高糖类抗原(CA)19-9、分化程度、淋巴结阳性是影响病人术后达到TO的相关因素(χ^(2)值分别为2.377、9.806、5.905、10.626、6.228、8.536、6.188、5.416、11.317,均P<0.05);多因素logistic回归分析显示:术中出血量>525 mL[OR=0.341,95%CI(0.130,0.895),P<0.05]、术前胆道引流[OR=0.311,95%CI(0.125,0.777),P<0.05]、开放胰十二指肠切除术[OR=0.946,95%CI(1.072,8.094),P<0.05]、淋巴结阳性[OR=0.228,95%CI(0.066,0.795),P<0.05]是影响壶腹周围癌达到TO的独立危险因素,Kaplan-Meier生存曲线显示,TO组第1、3年总生存率分别为100%、75.4%,非TO组第1、3年总生存率分别为71.4%、43.4%,差异均有统计学意义(均P<0.05)。结论根据胰十二指肠切除术后是否达到TO,可有效预测壶腹周围癌病人的预后情况,术中出血量>525 mL、术前胆道引流、开放胰十二指肠切除术、淋巴结阳性是影响壶腹周围癌达到TO的独立危险因素。

Objective To explore the risk factors for textbook outcome(TO)in patients with periampullary cancer after radical pancreaticoduodenectomy.Methods From December 2017 to December 2021,the relevant clinicopathological data were retrospectively reviewed for 134 patients with periampullary cancer undergoing radical pancreaticoduodenectomy.The correlations of 22 clinicopathological factors were examined.Firstly the correlation between clinical factors and TO was screened out by univariate analysis and then independent risk factors related TO were screened out by Logistic regression analysis.Results Among them,43(32.0%)reached TO and 91(67.9%)non-TO.Univariate analysis revealed that gender,intraoperative hemorrhage>525 mL,open pancreaticoduodenectomy,preoperative biliary drainage,preoperative asymptomatic leukocytosis,preoperative total bilirubin>22μmol/L,preoperative high CA19-9,degree of differentiation and positive lymph node were the related factors affecting postoperative TO(χ^(2)=2.377,9.806,5.905,10.626,6.228,8.536,6.188,5.416,11.317,P<0.05);Multivariate Logistic regression analysis indicated that intraoperative hemorrhage>525 mL,preoperative biliary drainage,open pancreaticoduodenectomy and positive lymph node were independent risk factors for TO(odds ratio=0.341,0.311,0.946,0.228,95%confidence intervals of 0.130~0.895,0.125~0.777,1.072~8.094,0.066-0.795,P<0.05).Conclusion It can effectively predict the prognosis of patients with periampullary cancer according to whether TO is achieved after duopancreaticotomy.Intraoperative hemorrhage>525 mL,preoperative biliary drainage,open pancreaticoduodenectomy and positive lymph node are an independent risk factor for TO.