文章摘要

胰十二指肠切除术后胰瘘发生的危险因素分析

作者: 1张波, 1阿布拉依马木买买提江·, 1易超, 2王敏, 2秦仁义, 3李海军
1 新疆医科大学附属肿瘤医院 肝胆胰外科，新疆 乌鲁木齐830011
2 华中科技大学同济医学院附属同济医院 肝胆 胰外科中心，湖北 武汉 430030
3 深圳大学附属罗湖医院 普外二科，广东 深圳518000
通讯: 李海军 Email: lhjun3408@163.com
DOI: 10.3978/.10.3978/j.issn.1005-6947.2015.03.004
基金: 新疆维吾尔自治区科技支疆计划资助项目, 201291170

摘要

目的：探讨胰十二指肠切除术（PD）后导致胰瘘（PF）发生的危险因素，为临床上PD 后PF 的防治 提供参考。 方法：回顾2010 年1 月—2014 年03 月期间新疆医科大学附属肿瘤医院收治的122 例行PD 术患者的 临床资料，针对可能与PF 相关的14 个危险因素进行单因素及多因素Logistic 回归分析。 结果：全组PF 发生率为13.9%（17/122）。单因素分析结果显示，上腹部手术史（P=0.024），术 前胆红素（P=0.003）、术中出血量（P=0.023）、术后血红蛋白（P=0.021）、胰腺质地（P=0.046）、 胰管直径（P=0.007）为PD 后发生PF 有意义的因素。多因素分析结果表明，上腹部手术史、胰管直 径<3 mm、术后血红蛋白<90 g/L 是PD 术后发生PF 的独立危险因素（OR=4.308、5.052、3.958，均 P<0.05）。 结论：对于上腹部手术史、胰管直径<3 mm、术后血红蛋白<90 g/L 的PD 患者，应采取相应的措施， 减少术后PF 的发生。
关键词： 胰十二指肠切除术 胰腺瘘 危险因素

Pancreatic fistula after pancreaticoduodenectomy: analysis of risk factors

Authors: 1ZHANG Bo, 1Abula YIMAMUMAIMAITIJIANG•, 1YI Chao, 2WANG Min, 2QIN Renyi, 3LI Haijun
1 Department of Hepatobiliary Surgery, Affiliated Cancer Hospital, Xinjiang Medical University, Urumqi 830011, China
2 Center of Hepatopancreatobiliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
3 The Second Department of General Surgery, Affiliated Luohu Hospital, Shenzhen University, Shenzhen, Guangdong 518000, China

CorrespondingAuthor:LI Haijun Email: lhjun3408@163.com

Abstract

Objective: To investigate the risk factors for occurrence of pancreatic fistula (PF) after pancreaticoduodenectomy (PD), so as to provide reference for prevention of PF after PD in clinical practice. Methods: The clinical data of 122 patients undergoing PD in Cancer Hospital affiliated to Xinjiang Medical University from January 2010 to march 2014 were reviewed. Fourteen factors potentially affecting the occurrence of PF were determined by univariate and multivariate Logistic regression analysis. Results: The incidence of PF in the whole group was 13.9% (17/122). Univariate analysis showed that history of upper abdominal surgery (P=0.024), preoperative bilirubin level (P=0.003), intraoperative blood loss (P=0.023), postoperative hemoglobin level (P=0.021), postoperative albumin level (P=0.046), and pancreatic duct diameter (P=0.007) were significantly associated with PF after PD. Multivariate analysis results demonstrated that the history of abdominal surgery, pancreatic duct diameter less than 3 mm, and postoperative hemoglobin level less than 90 g/L were independent risk factors for the occurrence of PF after PD (OR=4.308, 5.052, 3.958, all P<0.05). Conclusion: For PD patients with history of upper abdominal surgery, or with pancreatic duct diameter less than 3 mm or postoperative hemoglobin level less than 90 g/L, appropriate measures should be taken to reduce the incidence of PF after PD.
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