中国普外基础与临床杂志

中国普外基础与临床杂志

PD 后胰瘘的影响因素及胰瘘风险评分系统对胰十二指肠切除术后主胰管引流方式选择的价值

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目的 探索胰十二指肠切除术(PD)后胰瘘发生的影响因素,并根据胰瘘风险评分系统(FRS)评分分层比较胰十二指肠切除术后主胰管支撑管内引流与外引流胰瘘发生率的差异,旨在为临床最佳引流方案提供依据。 方法 回顾性分析徐州医科大学附属医院 2016 年 1 月至 2017 年 12 月期间收治的 76 例行胰十二指肠切除术患者的临床资料,探索胰瘘的相关危险因素,单因素分析采用成组 χ2 检验或 Fisher 精确概率法,多因素分析采用非条件 logistic 回归模型。根据 FRS 评分结果,探索不同风险下内外引流组胰瘘发生率的差异,统计方法采用成组 χ2 检验。 结果 76 例患者中,PD 后发生胰瘘 24 例,发生率为 31.5%。单因素分析结果显示,主胰管直径和胰腺质地是影响 PD 后胰瘘发生的相关因素(P<0.05);多因素分析结果显示,胰腺质软是 PD 后胰瘘发生的独立危险因素(OR=3.886,P<0.05),而引流方式不是 PD 后胰瘘发生的影响因素(P>0.05)。在可忽略不计风险者中,内引流组和外引流组均无胰瘘发生;在中等风险和低风险患者中,外引流组的的术后胰瘘发生率与内引流组相应患者比较差异均无统计学意义(P>0.05);但在高风险患者中,外引流组术后的胰瘘发生率较内引流组患者低,差异有统计学意义(P=0.026)。 结论 胰腺质地是影响 PD 后胰瘘发生的独立危险因素。FRS 高风险患者中,使用胰管支撑管外引流相比内引流能更有效地预防 PD 后胰瘘的发生。

Objective To explore the influencing factors of pancreatic fistula after pancreaticoduodenectomy (PD), and to compare the incidence of pancreatic fistula after pancreaticoduodenectomy with internal drainage of main pancreatic duct and external drainage according to the pancreatic fistula risk scoring (FRS) system, to provide the basis for the best drainage scheme in clinic. Methods The clinical data of 76 cases of PD treated in affiliated Hospital of Xuzhou Medical University from January 2016 to December 2017 were analyzed retrospectively, to explore the risk factors of pancreatic fistula. Single factor analysis was based on group chi-square test or Fisher exact probability method, and multivariate analysis was based on unconditioned logistic regression model. According to the results of FRS score, the difference of pancreatic fistula in different risk groups was explored. The statistical method was chi-square test. Results The incidence of pancreatic fistula after PD was 31. 5% in 76 patients.Univariate analysis showed that the diameter of the main pancreatic duct and the texture of the pancreas were the related factors affecting the occurrence of pancreatic fistula after PD (P<0.05), and the soft pancreas was the independent risk factor for the occurrence of pancreatic fistula after PD (OR=3.886, P<0.05). There was no significant difference in the incidence of postoperative pancreatic fistula between the internal drainage group and the external drainage group (P>0.05). There was no pancreatic fistula occurred in the 可忽略不计风险者?. The incidence of postoperative pancreatic fistula in patients with high risk of external drainage group was only 12.5%, comparing with patients in internal drainage group (63.6%), the difference was statistically significant (χ2=4.968, P=0.026). There was no significant difference in the incidence of postoperative pancreatic fistula between patients in the external drainage group with moderate risk and low risk compared with the corresponding patients in the internal drainage group (P>0.05). Conclusions Pancreatic texture was an independent risk factor for pancreatic fistula after PD. External drainage maybe more effective than internal drainage in preventing pancreatic fistula after PD in patients with high risk of FRS.

关键词: 胰瘘; 胰十二指肠切除术; 胰瘘风险评分系统; 引流术

Key words: pancreaticoduodenectomy; pancreatic fistula risk score; drainage;  

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