摘要目的 探讨胰十二指肠切除术后发生高淀粉酶血症的预后因素.方法 前瞻性收集2017年1月至2018年6月海军军医大学长海医院同一团队完成的359例胰十二指肠切除术患者的临床资料.男性212例,女性147例,中位年龄63岁(范围:23～82岁).以术后0～1d血清淀粉酶120 U/L为界,将患者分为高淀粉酶血症组和非高淀粉酶血症组.采用单因素分析、Logistic回归多因素分析的方法,分析胰十二指肠切除术后发生高淀粉酶血症的预后因素.结果 359例患者中,术后发生高淀粉酶血症238例(66.3％).高淀粉酶血症组患者的临床相关胰瘘(CR-POPF)(15.1％比2.5％;x2=13.249,P＜0.01)、中重度出血(8.8％比2.5％;x2=5.176,P＜0.01)、腹腔感染(9.2％比3.3％;x2=4.210,P=0.04)发生率明显高于非高淀粉酶血症组.高淀粉酶血症组患者并发症严重程度(CD分级≥Ⅲ级:11.3％比4.1％;x2=5.139,P=0.023)和术后住院时间(11d比9d,P=0.001)亦高于非高淀粉酶血症组.对高淀粉酶血症的多因素分析结果显示,主胰管直径≤3 mm(OR=4.469,95％CI:2.563～7.793,P＜0.01)、病理学类型为胰腺癌或胰腺炎(OR=0.230,95％CI:0.122～0.436,P＜0.01)及胰腺质软(OR=3.297,95％CI:1.930～5.635,P＜0.01)是高淀粉酶血症的独立预后因素.结论 胰十二指肠切除术后高淀粉酶血症增加了患者术后并发症的发生率和严重程度,主胰管较细、胰腺质软及病理学类型为胰腺癌或胰腺炎是胰十二指肠切除术后高淀粉酶血症的独立预后因素.

abstractsObjective To investigate the prognostic factors of hyperamylasemia following pancreaticoduodenectomy(PD).Methods Clinical data of 359 patients were collected prospectively who underwent PD by the same group at Changhai Hospital of Navy Medical University from January 2017 to June 2018.There were 212 males and 147 females.The median age was 63 years old (range:23 to 82 years old).According to whether the patient's serum amylase was greater than 120 U/L at 0 or 1 day after surgery,the patients were divided into hyperamylasemia group and non-hyperamylasemia group.Univariate analysis and multivariate analysis were used to find out the prognostic factors of hyperamylasemia after PD.Results Of the 359 patients,238 cases(66.3％) developed hyperamylasemia.The incidence rate of clinically related pancreatic fistula(15.1％ vs.2.5％,P＜0.01),grade B/C post pancreatectomy hemorrhage (8.8％ vs.2.5％,P＜0.01),and surgical site infection(9.2％ vs.3.3％,P=0.04) was significantly higher in the hyperamylasemia group.The severity of complications(CD grade≥ Ⅲ:1 1.3％ vs.4.1％,P=0.023) and postoperative hospital stay (11 days vs.9 days,P=0.001) were higher in the hyperamylasemia group.In the multivariate analysis,the main pancreatic duct diameter(MPD) ≤3 mm(OR=4.469,95％ CI:2.563-7.793,P＜0.01),pathological type of disease (pancreatic cancer or pancreatitis)(OR=0.230,95％ CI:0.122-0.436,P＜0.01) and soft texture of pancreas(OR=3.297,95％CI:1.930-5.635,P＜0.01) were independent prognostic factors for hyperamylasemia.Conclusions Post-PD hyperamylasemia increased the incidence and severity of postoperative complications after PD.MPD≤3 mm,soft texture of pancreas and pathological type of disease were independent prognostic factors of hyperamylasemia.