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胰十二指肠切除术后胰瘘相关危险因素分析

Analysis of pancreatic leaking-related risk factors after pancreaticoduodenectomy

摘要:

目的 探讨胰十二指肠切除术后胰瘘发生的相关危险因素.方法 回顾性分析2001年6月至2006年6月间97例采用标准胰腺十二指肠切除术(PD)和传统Child法消化道重建患者的临床资料,分别对围手术期可能与胰瘘发生相关的因素进行分析比较.通过单因素分析与多因素分析筛选出与PD术后胰瘘发生相关的因素. 结果 97例PD术后患者中,发生胰瘘13例.单因素分析结果显示,术前血清胆红素水平≥170 mmol/L(P=0.038)、手术时间(P=0.003)、胃肠吻合口下方输入段与输出段之间加做Braun吻合(P=0.034)及术后预防性应用生长抑素(P=0.003)与PD术后胰瘘的发生相关;多因素分析结果显示,术前血清胆红素水平≥170 mmol/L(OR=11.687,P=0.021)是术后胰瘘发生的独立危险因素,而术后预防性应用生长抑素(OR=0.056,P=0.016)是胰瘘发生的保护因素. 结论 术前血清胆红素水平≥170 mmol/L是PD术后胰瘘发生的危险因素,术后预防性应用生长抑素可以减少胰瘘的发生.

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abstracts:

Objective To analysis the risk factors of pancreatic fistula after pancreaticoduodenectomy(PD). Methods A retrospective clinical study had been done in 97 patients who underwent PD between June 2001 and June 2006.The two groups were first compared by the univariate analysis;logistic regression was then used to determine the effect of multiple factors on pancreatic fistula.A P-value of less than 0.05 was considered to be statistically significant.Results Of the 97 patients,13 patients were identified as having pancreatic fistula.Factors significantly increasing the risk of pancreatic fistula by univariate analysis included preoperative serum total bilirubin(P=0.038),operative time(P=0.003) and whether or not Braun anastomosis(P=0.034),and prophylactic use of somatostatin(P=0.003) after operation.A multivariate logistic regression analysis revealed the factors most highly associated with pancreatic fistula to be preoperative serum total bilirubin (OR=11.687,P=0.021) and postoperative prophylactic use of somatostatin(OR=0.056,P=0.020).Conclusions Preoperative serum total bilirubin more than 170 mmol/L was a risk factor of pancreatic fistula after PD,and postoperative prophylactic use of somatostatin was a protect factor of pancreatic fistula after PD.

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