胰十二指肠切除术后发生胰瘘的危险因素分析

目的:探讨胰十二指肠切除术(pancreaticoduodenectomy,PD)后发生胰瘘的危险因素。方法:回顾性分析郑州大学第一附属医院2008年6月至2013年6月期间接受胰十二指肠切除术的158例患者的临床资料,并对围手术期可能与胰瘘发生有关的因素进行单因素及Logistic多因素分析。结果:本组患者术后胰瘘发生率为9.5%(15/158),胰瘘相关死亡率13.3%。单因素分析结果显示:体质量指数(BMI)、胰腺质地、胰肠吻合口缝合方式是胰瘘发生的相关因素(P<0.05)。多因素分析显示:胰瘘发生的独立危险因素为BMI>25(OR=4.670)、胰腺质软(OR=6.035)、吻合口采用丝线间断缝合(OR=3.607)。结论:BMI>25、胰腺质软、吻合口采用丝线间断缝合预示着较高的胰瘘发生率。有效的术前评估、丰富的手术经验、采用合适的胰肠吻合方式是减少术后胰瘘的有效途径。

Analysis of risk factors for pancreatic fistula after pancreaticoduodenectomy

Objective ： To explore the risk factors for pancreatic fistula after pancreaticoduodenectomy（PD）. Methods： The clinical data of 158 patients receiving PD in the First Affiliated Hospital of Zhengzhou University between June 2008 and June 2013 were studied. And the potential perioperative factors for pancreatic fistula were analyzed with univariate and multivariate logistic regression model. Results： The incidence of postoperative pancreatic fistula was 9.5% （15/158） in the group of patients, and the mortality associated with pancreatic fistula was 13.3%. Univariate anal- ysis showed that BMI, pancreatic texture and the different anastomosis patterns were associated with postoperative pancreatic fistula （P 〈 0.05 ）. Multivariate analysis announced that BMI 〉 25 （ OR = 4. 670） , soft pancreas （ OR = 6. 035 ） , interrupted suture （ OR = 3. 607 ） were independent risk factors for postoperative pancreatic fistula. Conclusion ： BMI 〉 25, soft pancreas, interrupted suture predict a high probability of pancreatic fistula after PD. Effective preoperative evaluation, surgeon with rich experience and using appropriate pancreaticojejunostomy is the efficient path for reducing the incidence of postoperative pancreatic fistula.