摘要
目的探讨腹腔镜胰十二指肠切除术后B、C级胰漏发生的预后因素。方法回顾性分析2016年12月～2018年6月83例腹腔镜胰十二指肠切除术的临床资料,对可能与B、C级胰漏有关的围手术期因素进行分析。单因素分析采用χ~2检验,有统计学意义的因素采用非条件logistic回归分析进行多因素分析。结果 83例中11例(13.3%)发生术后B、C级胰漏,其中B级9例(10.8%),C级2例(2.4%)。logistic回归多因素分析显示,术前总胆红素≥171μmol/L (OR=4.636,95%CI:1.080～19.894,P=0.039)、胰腺质地柔软(OR=0.202,95%CI:0.047～0.866,P=0.031)与B、C级胰漏的发生密切相关。BMI≥25(OR=22.347,95%CI:1.462～341.501,P=0.026)、术后未应用生长抑素(OR=0.071,95%CI:0.006～0.799,P=0.032)是胰腺质地柔软患者术后B、C级胰漏发生的相关因素。BMI≥25 (OR=13.474,95%CI:1.258～144.322,P=0.032)、术前采取减黄措施(OR=0.057,95%CI:0.005～0.638,P=0.020)是术前总胆红素≥171μmol/L患者术后B、C级胰漏发生的影响因素。结论胰腺质地柔软及术前总胆红素≥171μmol/L与腹腔镜胰十二指肠切除术后B、C级胰漏发生密切相关。BMI≥25时,此类患者B、C级胰漏发生风险明显增加。当术前总胆红素≥171μmol/L时,宜术前采取减黄措施。对于胰腺质软者,预防性应用生长抑素可在一定程度上降低腹腔镜胰十二指肠切除术后B、C级胰漏发生风险。
Objective To investigate the prognostic factors of grade B and C pancreatic leakage after laparoscopic pancreaticoduodenectomy. Methods Clinical data of 83 cases of laparoscopic pancreaticoduodenectomy performed from December 2016 to June 2018 in our hospital were retrospectively analyzed. The risk factors associated with peri-operative grade B and C pancreatic leakage were analyzed. The univariate analysis were conducted by using the chi-square test. Logistic regression model was used for multivariate analysis. Results The grade B and C pancreatic leakage developed in 11 ( 13. 3%) patients after surgery, with grade B in 9 ( 10. 8%) patients and grade C in 2 ( 2. 4%) patients. The multivariate analysis by using logistic regression identified two variables as independent factors associated with grade B and C pancreatic leakage,namely,preoperative total bilirubin level ≥171 μmol /L ( OR = 4. 636,95% CI: 1. 080 - 19. 894,P = 0. 039) and soft pancreatic texture ( OR = 0. 202,95% CI: 0. 047 - 0. 866,P = 0. 031 ). The BMI ≥ 25 ( OR = 22. 347,95% CI: 1. 462 - 341. 501,P = 0. 026 ) and the non-use of somatostatin after surgery ( OR = 0. 071,95% CI: 0. 006 - 0. 799,P = 0. 032) were the related factors for patients with soft pancreatic texture. The BMI ≥ 25 ( OR = 13. 474,95% CI: 1. 258 - 144. 322,P = 0. 032) and preoperative biliary drainage ( OR = 0. 057, 95% CI: 0. 005 - 0. 638,P = 0. 020) were predictors of grade B and C pancreatic leakage for patients with high preoperative total bilirubin level (≥171 μmol /L). Conclusions Soft pancreatic texture and preoperative high total bilirubin level (≥171 μmol /L) are closely related to the occurrence of grade B and C pancreatic leakage after laparoscopic pancreaticoduodenectomy. In case of IBM ≥ 25,the risk of grade B and C pancreatic leakage increases significantly. When the preoperative total bilirubin level is higher than 171 μmol /L,it is advisable to give preoperative biliary drainage. For patients with soft pancreas,prophylactic use of somatostatin can reduce the risk of grade B and C pancreatic leakage after laparoscopic pancreaticoduodenectomy.
作者
王振勇
刘汝海
李凤山
张执全
袁俊健
Wang Zhenyong;Liu Ruhai;Li Fengshan(Department of General Surgery,Cangzhou Central Hospital,Cangzhou 061000,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2019年第2期106-110,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜胰十二指肠切除术
胰漏
预后因素
Laparoscopic pancreaticoduodenectomy
Pancreatic leakage
Prognostic factor
