腹腔镜胰腺肿瘤剜除术后胆道并发症的危险因素分析

Risk factors of biliary complications after laparoscopic pancreatic tumor enucleation

目的:探讨腹腔镜胰腺肿瘤剜除术后发生胆道并发症的危险因素。方法:回顾分析2017年3月至2023年6月101例接受腹腔镜胰腺肿瘤剜除术患者的临床及随访资料。其中男29例,女72例,15~77岁,平均(48.6±13.2)岁。肿瘤位于胰头部49例(48.5%)、胰颈体尾部52例(51.5%)。根据术后是否发生胆道并发症分为胆道并发症组(n=24)与无胆道并发症组(n=77)。单因素分析中定量数据采用t检验或Mann-Whitney U检验进行比较,分类数据采用χ^(2)检验进行比较,采用多因素Logistic回归分析术后发生胆道并发症的独立危险因素。结果:患者均在腹腔镜下顺利完成肿瘤剜除术,无术中输血及中转开腹,手术时间63~359 min,平均(168.0±58.7)min。术后长期随访,24例(23.8%)发生胆道并发症,其中胆囊结石21例、胆囊炎2例、胆囊结石合并胆总管结石1例;77例(76.2%)未发生胆道并发症。单因素分析结果显示,体重指数大(P=0.008)、术后第1天γ-谷氨酰转移酶高(P=0.04)、肿瘤位于胰头部(P=0.012)、肿瘤最大径长(P=0.028)、生长抑素使用总量多(P<0.001)是术后发生胆道并发症的危险因素。将上述危险因素纳入多因素Logistic回归分析,结果显示体重指数大(OR=1.262,95%CI=1.025~1.554,P=0.028)、肿瘤位于胰头部(OR=4.042,95%CI=1.242~13.155,P=0.020)、生长抑素使用总量多(OR=1.381,95%CI=1.059~1.800,P=0.017)是腹腔镜胰腺肿瘤剜除术后发生胆道并发症的独立危险因素。结论:腹腔镜胰腺肿瘤剜除术是治疗胰腺良性、低度恶性肿瘤的有效术式,对于具有上述危险因素的患者,应在出院后加强监测胆道并发症的发生情况。

Objective:To investigate the risk factors of biliary complications after laparoscopic pancreatic tumor enucleation.Methods:The clinical and follow-up data of 101 patients who underwent laparoscopic pancreatic tumor enucleation from Mar.2017 to Jun.2023 were retrospectively analyzed.There were 29 males and 72 females,with the average age of(48.6±13.2)years(range:15 to 77 years).The tumors located in the head of the pancreas in 49 cases(48.5%)and in the neck and tail of the pancreas in 52 cases(51.5%).According to the presence or absence of biliary complications,the patients were divided into biliary complications group(n=24)and non-biliary complications group(n=77).In univariate analysis,quantitative data were compared by t test or Mann-Whitney U test,and categorical data were compared byχ^(2) test.Multivariate logistic regression analysis was used to analyze the independent risk factors of postoperative biliary complications.Results:All patients successfully underwent laparoscopic enucleation without intraoperative blood transfusion and conversion to open surgery.The operation time was(168.0±58.7)min(range:63 to 359 min).After long-term follow-up,biliary complications occurred in 24 patients(23.8%),including 21 cases of gallstones,2 cases of cholecystitis and 1 case of cholecystolithiasis combined with choledocholithiasis.Seventy-seven patients(76.2%)had no biliary complications.Univariate analysis showed that higher body mass index(P=0.008),higherγ-glutamyl transpeptidase level on the first postoperative day(P=0.04),tumor located in the head of the pancreas(P=0.012),longer maximum tumor diameter(P=0.028)and more somatostatin dosage(P<0.001)were risk factors for postoperative biliary complications.The above risk factors were included in multivariate logistic regression analysis,and the results showed that high body mass index(OR=1.262,95%CI=1.025~1.554,P=0.028),tumor located in the head of the pancreas(OR=4.042,95%CI=1.242~13.155,P=0.020),and large amount of somatostatin dosage(OR=1.381,95%CI=1.059~1.800,P=0.017)were independent risk factors for biliary complications after laparoscopic pancreatic tumor enucleation.Conclusions:Laparoscopic enucleation of pancreatic tumor is an effective method for the treatment of benign and low malignant pancreatic tumors.For patients with the above risk factors,the occurrence of biliary complications should be monitored after discharge.