恶性梗阻性黄疸根治性胰十二指肠切除术后黄疸消退不良的影响因素分析

目的探讨恶性梗阻性黄疸根治性胰十二指肠切除术后黄疸消退不良的影响因素。方法采用回顾性病例对照研究方法。收集2013年3月至2018年6月南京医科大学附属常州第二人民医院收治的121例恶性梗阻性黄疸患者的临床病理资料;男70例,女51例;年龄为(69±9)岁,年龄范围为39~85岁。121例患者中,112例行开腹根治性胰十二指肠切除术,9例行全腹腔镜根治性胰十二指肠切除术。观察指标:(1)术后黄疸消退情况。(2)术后黄疸消退不良的影响因素分析。正态分布的计量资料以±s表示,偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。单因素分析采用χ2检验、t检验、Fisher确切概率法或Mann-Whitney U检验,将P<0.10的因素纳入多因素分析,多因素分析采用Logistic回归模型。结果(1)术后黄疸消退情况:121例患者中,97例术后黄疸消退良好,24例术后黄疸消退不良。(2)术后黄疸消退不良的影响因素分析:单因素分析结果显示术前总胆红素、合并糖尿病是术后黄疸消退不良的影响因素(t=-2.073,χ2=10.201,P<0.05)。术后胰瘘是术后黄疸消退不良的影响因素(P<0.05)。多因素分析结果显示合并糖尿病和术后胰瘘是术后黄疸消退不良的独立危险因素(比值比=0.258,0.129,95%可信区间为0.087~0.769,0.023~0.726,P<0.05)。结论术前总胆红素、合并糖尿病、术后胰瘘是恶性梗阻性黄疸患者根治性胰十二指肠切除术后黄疸消退不良的影响因素;合并糖尿病和术后胰瘘是术后黄疸消退不良的独立危险因素。

Influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice

Objective To investigate the influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice.Methods The retrospective case-control study was conducted.The clinicopathological data of 121 patients with malignant obstructive jaundice who were admitted to the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University between March 2013 and June 2018 were collected.There were 70 males and 51 females,aged(69±9)years,with a range from 39 to 85 years.Of 121 patients,112 underwent open radical pancreaticoduodenectomy,and 9 underwent totally laparoscopic radical pancreaticoduodenectomy.Observation indicators:(1)situations of jaundice resolution after pancreaticoduodenectomy;(2)influencing factors for poor jaundice resolution after pancreaticoduodenectomy.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Univariate analysis was performed using the chi-square test,t test,Fisher exact probability or Mann-Whitney U test.Multivariate analysis was performed by the Logistic regression model using P<0.10 as an inclusion criteria in the univariate analysis.Results(1)Situations of jaundice resolution after pancreaticoduodenectomy:of 121 patients,97 had good jaundice resolution after pancreaticoduodenectomy,and 24 had poor jaundice resolution after pancreaticoduodenectomy.(2)Influencing factors for poor jaundice resolution after pancreaticoduodenectomy:results of univariate analysis showd that preoperative level of serum total bilirubin,comorbidity with diabetes mellitus were influencing factors for poor jaundice resolution after pancreaticoduodenectomy(t=-2.073,χ2=10.201,P<0.05).Postoperative pancreatic fistula was also an influencing factor for poor jaundice resolution after pancreaticoduodenectomy(P<0.05).Results of multivariate analysis showed that comorbidity with diabetes mellitus and postoperative pancreatic fistula were independent risk factors for poor jaundice resolution after pancreaticoduodenectomy(odds ratio=0.258,0.129,95%confidence interval:0.087-0.769,0.023-0.726,P<0.05).Conclusions Preoperative level of serum total bilirubin,diabetes mellitus,and postoperative pancreatic fistula are influencing factors for poor jaundice resolution after pancreaticoduodenectomy.Comorbidity with diabetes mellitus and postoperative pancreatic fistula are independent risk factors for poor jaundice resolution after pancreaticoduodenectomy.