胰十二指肠切除术后胰漏的影响因素分析

摘要

Objective To analyze the predisposing factors for pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 323 patients undergoing pancreaticoduodenectomy from January 2007 to March 2012 were analyzed retrospectively.There were 185 male and 138 female patients,aging from 27 to 82 years.All the patients were devided into pancreatic fistula group (n = 52) and non-pancreatic fistula group (n = 271).Twenty variables,such as age,sex,primary disease,alcohol abuse,cholangitis,bilirubin,albumin,hemoglobin,operating time,blood loss,transfusion,texture of the remnant pancreas,diameter of wirsung,drainages of pancreatic duct,specialized group which potentially affect the incidence,were analyzed by t test for continuous variables and x2 test for discrete variables.The variables with significance (P ＜ 0.05) were then analyzed with Logistic regression model.Results Of all the 323 patients,the overall morbidity rate was 30.3％ (98/323),and the mortality was 3.7％ (12/323).Pancreatic fistula rate was 16.1％ (52/323),7 patients died for pancreatic fistula PF.In univariate analysis,primary disease,preoperative high bilirubin level,intraoperative blood loss and transfusion,texture of the remnant pancreas,diameter of wirsung,drainages of pancreatic duct,specialized group had significant difference between two groups (x2 = 4.072 to 9.008,P ＜ 0.05).Multivariate logistic regression analysis revealed that primary disease (OR = 2.091,P = 0.001),texture of the remnant pancreas (OR =7.715,P = 0.040),diameter of wirsung (OR = 5.405,P = 0.006),pancreatic duct stent (OR = 4.313,P =0.001) and specialized group (OR = 6.404,P = 0.006) were independent risk factors in pancreatic fistula.Conclusions Primary disease,texture of the remnant pancreas,diameter of wirsung,pancreatic duct stent and specialized group are independent risk factors in pancreatic fistula.With the purpose of decreasing pancreatic fistula rate after PD,it is necessary to operate meticulously and precisely,place external pancreatic duct stent and establish pancreatic center or specialized group.%目的 探讨影响胰十二指肠切除术(PD)后胰漏发生的相关影响因素.方法 回顾性分析2007年1月至2012年3月323例PD患者的临床资料,其中男性185例,女性138例；年龄27～82岁.根据是否发生胰漏分为胰漏组52例及非胰漏组271例.对围手术期可能产生胰漏的20个相关因素,如年龄、性别、原发疾病、酗酒史、胆管炎、胆红素、清蛋白、血红蛋白等进行单因素分析及非条件Logistic多因素分析.结果 全部323例PD术后总并发症发生率30.3％(98/323),病死率3.7％(12/323),其中胰漏发生率16.1％(52/323),因胰漏死亡7例.单因素分析显示,两组间原发疾病、术前胆红素、术中出血量、输血量、胰腺质地、胰管直径、胰管支架引流方式、专业组差异有统计学意义(x2=4.072 ～9.008,P＜0.05).多因素分析显示:原发病(OR= 2.091,P=0.001)、胰腺质地(OR=7.715,P=0.040)、胰管直径(OR=5.405,P=0.006)、胰管支架引流方式(OR =4.313,P=0.001)及专业组(OR =6.404,P =0.006)是胰漏的独立危险因素.结论 原发疾病、胰腺质地、胰管直径、胰管支架引流方式及专业组是胰漏发生的独立危险因素.手术精准操作,术中放置胰管支架外引流,成立胰腺外科专业组能够有效降低胰漏的发生率.