腹腔镜胰十二指肠切除术后30天内非计划再手术的危险因素分析

Analysis of the risk factors for 30-day unplanned reoperation after laparoscopic pancreatoduodenectomy

目的分析腹腔镜胰十二指肠切除术(LPD)术后30 d内非计划再手术的危险因素。方法回顾性分析宁波大学附属李惠利医院2017年2月至2022年10月行LPD的207例患者临床资料,其中男性118例,女性89例,年龄(65.1±11.1)岁。根据术后30 d内是否行非计划再手术将患者分为再手术组(15例)和非再手术组(192例),利用单因素及多因素logistic回归分析非计划再手术的危险因素。结果LPD术后30 d内非计划再手术率为7.2%(15/207)。再手术组患者并发症发生率为80%(12/15),死亡率为13.3%(2/15),术后住院时间为(32.9±20.1)d,均高于非再手术组的并发症发生率40.1%(77/192)(χ^(2)=9.04,P=0.003)、死亡率0.5%(1/192)(χ^(2)=8.28,P=0.004)、术后住院时间(17.9±8.6)d(t=-2.79,P=0.014),差异有统计学意义。非计划再手术与糖尿病、术中出血>130 ml、术前血清前白蛋白<0.15 g/L、胰腺质地、胰管直径有关(均P<0.05)。多因素logistic回归分析显示糖尿病(OR=4.991,95%CI:1.431~17.415)、术前血清前白蛋白水平<0.15 g/L(OR=4.067,95%CI:1.178~14.043)、胰腺质软(OR=3.900,95%CI:1.146~13.272)、胰管直径≤3 mm(OR=3.449,95%CI:1.009~11.789)是LPD患者30 d内行非计划再手术的独立危险因素(均P<0.05)。结论术前糖尿病、术前血清前白蛋白<0.15 g/L、胰腺质软、胰管直径≤3 mm是影响患者术后30 d内非计划再手术的独立危险因素。

ObjectiveTo study the risk factors of unplanned reoperation within 30 days after laparoscopic pancreaticoduodenectomy(LPD).MethodsThe clinical data of 207 patients who underwent LPD in the Lihuili Hospital Affiliated to Ningbo University from February 2017 to October 2022 were retrospectively analyzed.There were enrolled 118 males and 89 females,aged(65.1±11.1)years old.Patients were divided into the reoperation group(n=15)and non-reoperation group(n=192)based on whether unplanned reoperation was performed within 30 days after LPD.The risk factors of unplanned reoperation were analyzed with univariate and multivariate logistic regression analysis.ResultsThe rate of unplanned reoperation within 30 days after LPD was 7.2%(15/207).The unplanned reoperation group exhibited a higher incidence of complications 80%(12/15),mortality 13.3%(2/15),and extended hospital stay(32.9±20.1)d compared to the non-reoperation group,which incidences of complications,mortality and extended hospital stay were 40.1%(77/192)(χ^(2)=9.04,P=0.003),0.5%(1/192)(χ^(2)=8.28,P=0.004),and(17.9±8.6)d(t=-2.79,P=0.014),respectively.Unplanned reoperation was associated with diabetes,intraoperative bleeding>130 ml,preoperative serum prealbumin<0.15 g/L,pancreatic texture and pancreatic duct diameter(all P<0.05).Multivariate logistic regression analysis identified diabetes(OR=4.991,95%CI:1.431-17.415),preoperative serum prealbumin<0.15 g/L(OR=4.06,95%CI:1.178-14.043),soft pancreatic texture(OR=3.900,95%CI:1.146-13.272)and pancreatic duct diameter≤3 mm(OR=3.449,95%CI:1.009-11.789)as independent risk factors for unplanned reoperation within 30 days.ConclusionPreoperative diabetes,preoperative serum prealbumin levels<0.15 g/L,soft pancreatic texture and pancreatic duct diameter≤3 mm were independent risk factors for unplanned reoperation within 30 days after LPD.