胰十二指肠切除术后胰瘘的相关因素分析

目的：探讨胰十二指肠切除术（PD）后胰瘘发生的相关危险因素，为预防胰瘘的发生提供参考依据。方法：72例患者均采用标准PD术式，重建顺序均为Child法。观察术后并发症和与胰瘘可能有关的患者年龄、性别、术前白蛋白水平、术前胆红素水平、术中输血量、手术时间、残余胰腺质地、胰管直径及术前是否合并糖尿病等9个因素。并行单因素及logistic多因素分析。结果：术后发生各种并发症30例，总发生率为41．7％；病死率为4．2％，胰瘘发生率为11．1％。logistic多因素回归分析表明，残余胰腺质地软及胰管直径〈3mm均为胰瘘发生的独立危险因素（P〈0．01和P〈0．05）。结论：胰腺质地软及胰管直径细小预示PD后胰瘘的发生率较高。

The related factors analysis of pancreatic fistula after pancreatoduodenectomy

Objective： To explore the risk factors of pancreatic fistula after pancreatoduodenectomy （PD） so as to provide the theoretical basis for preventing pancreatic fistula. Methods： Seventy-two patients were treated with standard PD surgical method, all reconstruction orders followed the Child act. The postoperative complications and age, gender, preoperative albumin level, preoperative bilirubin level, intraoperative blood transfusion, operative time, residual pancreatic texture, pancreatic duct diameter and preoperative diabetes of patients with pancreatic fistula were observed. The data were analyzed by univariate analysis and multivariate logistic analysis. Results：Postoperative complications occurred in 30 cases, the total occurrence rate of which was 41.7%. The rate of mortality and occurrence rate of pancreatic fistula were 4.2% and 1 I. 1%, respectively. Multivariate logistic regression analysis showed that the pliable texture residual pancreas and pancreatic duct diameter with less than 3 mm were the independent risk factors of pancreatic fistula（P 〈 0. 01 and P 〈 0. 05 ）. Conclusions： Small pancreatic duct diameter and pliable pancreatic texture predict the high occurrence of pancreatic fistula after PD.