腹腔镜胰十二指肠切除术术后C级胰瘘患者临床特征及影响因素研究

Clinical characteristics and influencing factors of patients with grade C pancreatic fistula after laparoscopic pancreaticoduodenectomy

目的:分析腹腔镜胰十二指肠切除术(LPD)术后C级胰瘘患者的临床特征及影响因素。方法:回顾性分析2020年1月至2023年12月行LPD的265例患者资料,术后发生并发症共76例(28.7%),根据术后C级胰瘘发生与否分为C级胰瘘组(n=17例)和非C级胰瘘组(n=59例)。分析LPD术后C级胰瘘患者临床特征。采用统计学软件SPSS 26.0进行统计学分析。采用多因素Logistic回归分析LPD术后C级胰瘘发生的影响因素。P<0.05差异有统计学意义。结果:265例患者均顺利完成LPD,其中发生生化漏8例(3.0%),B级胰瘘19例(7.2%),C级胰瘘共17例(6.4%),其它并发症共45例(17.0%)。C级胰瘘组和非C级胰瘘组患者年龄、BMI、胰腺CT值、胰管直径、胰肠重建方式、ASA分级、术中出血量、术前及术后PTA比较,差异均有统计学意义(P<0.05)。多因素分析显示,胰腺CT值≤40Hu、CT胰管直径≤2mm、术后PTA≤75%是LPD术后C级胰瘘发生的独立危险因素(P<0.05),而胰肠吻合方式中主胰管空肠桥式导管内引流重建是C级胰瘘发生的保护因素(P<0.05)。结论:胰腺CT值≤40Hu、CT胰管直径≤2mm、术后PTA≤75%是LPD术后C级胰瘘发生的独立危险因素,而胰肠吻合方式中主胰管空肠桥式导管内引流重建是C级胰瘘发生的保护因素。

Objective:To analyze the clinical features and influencing factors of grade C pancreatic fistula after laparoscopic pancreaticoduodenectomy(LPD).Methods:Data of 265 patients with LPD from January 2020 to December 2023 were retrospectively analyzed.A total of 76 patients(28.7%)developed postoperative complications,and were divided into Grade C pancreatic fistula group(n=17 cases)and non-grade C pancreatic fistula group(n=59 cases)according to the occurrence of postoperative grade C pancreatic fistula.To analyze the clinical features of patients with grade C pancreatic fistula after LPD.Statistical software SPSS 26.0 was used for statistical analysis.Multivariate Logistic regression was used to analyze the factors affecting the occurrence of Grade C pancreatic fistula after LPD.P<0.05 was statistically significant.Results:All 265 patients successfully completed LPD,including 8 cases(3.0%)of biochemical leakage,19 cases(7.2%)of B-grade pancreatic fistula,17 cases(6.4%)of C-grade pancreatic fistula,and 45 cases(17.0%)of other complications.There were statistically significant differences in age,BMI,pancreatic CT value,pancreatic duct diameter,pancreatic bowel reconstruction mode,ASA grade,intraoperative blood loss,and preoperative and postoperative PTA between grade C pancreatic fistula group and non-grade C pancreatic fistula group(P<0.05).Multivariate analysis showed that CT value of pancreas≤40Hu,CT pancreatic duct diameter≤2mm,and postoperative PTA≤75%were independent risk factors for C-grade pancreatic fistula after LPD(P<0.05),and reconstruction of main pancreatic duct jejunal bridge intraductal drainage in pancreatic enterostomy was protective factor for C-grade pancreatic fistula(P<0.05).Conclusion:CT value of pancreas≤40Hu,CT pancreatic duct diameter≤2mm,and postoperative PTA≤75%are independent risk factors for C-grade pancreatic fistula after LPD,and the reconstruction of main pancreatic duct and jejunal bridge intraductal drainage in pancreatic enterostomy is a protective factor for C-grade pancreatic fistula.