摘要
目的 探讨胰十二指肠切除术（PD）术后发生胰瘘的预后因素及其与胰腺纤维化的关系.方法 回顾性分析第三军医大学第一附属医院肝胆外科2013年1月至2015年12月收治的408例行胰十二指肠切除术患者的临床资料.男性274例,女性134例,年龄14～ 82岁,平均54.6岁.术后病理诊断：胰腺导管腺癌285例,胃肠来源肿瘤81例,神经内分泌肿瘤13例,炎症性改变16例,胰腺乳头状瘤8例,浆液性囊腺瘤4例,腹膜后脂肪肉瘤1例.单因素分析采用Pearsonx2检验,多因素分析采用二分类Logistic回归分析,相关性分析采用Spearman秩相关分析,胰腺纤维化程度对PD术后胰瘘的预测价值采用受试者工作特征（ROC）曲线下面积.结果 408例患者共发生PD术后胰瘘123例（30.1％）.单因素分析结果显示,体重指数（BMI） （P=0.005）、术前y-谷氨酰转肽酶（P=0.046）、胰管直径（P=0.001）、胰腺组织CT值（P=0.049）、手术时间（P=0.037）、胰腺硬度（术中判断）（P=0.001）和胰腺小叶纤维化百分比（P=0.034）为PD术后发生胰瘘的预后因素;多因素分析结果显示,BMI ≥25 kg/m2、胰管直径≤3 mm、胰腺组织CT值＜40 Hu、胰腺质地软（术中判断）和胰腺小叶纤维化百分比≤25％为PD术后发生胰瘘的预后因素（P值均＜0.05）;PD术后发生胰瘘的患者胰腺CT值和胰腺小叶纤维化百分比均低于未发生胰瘘的患者,差异均有统计学意义（P值均＜0.05）.不同等级胰瘘患者的胰腺CT值和胰腺小叶纤维化百分比相比,差异均有统计学意义（P=0.005、0.019）.胰瘘严重程度与胰体部CT值、胰腺小叶纤维化百分比呈负相关（r=-0.288、-0.324,P值均＜0.05）,且二者之间存在明显的相关关系（r=0.699,P=0.028）.胰腺小叶纤维化百分比及胰体部CT值曲线下面积分别为0.745和0.714,均对PD术后胰瘘具有中等预测价值.结论 胰腺纤维化程度是影响胰腺质地及PD术后胰瘘的预后因素,胰体部CT值可作为胰腺纤维化程度的量化指标,预测PD术后发生胰瘘的风险.
Objective To explore the risk factors of pancreatic fistula after pancreatoduodenectomy and its relationship with pancreatic fibrosis.Methods Retrospective analysis was made including 408 patients who underwent pancreaticoduodenectomy from January 2013 to December 2015 in Department of Hepatobiliary Surgery of the First Affiliated Hospital of Third Military Medical University.There were 274 males and females,aging from 14 to 82 years with an average age of 54.6 years.Postoperative pathological diagnosis：285 cases with pancreatic ductal adenocarcinoma,81 cases with gastrointestinal tumors,13 cases with neuroendocrine tumors,16 cases with inflammatory changes,8 cases with pancreatic papillary tumors,4 cases with serous cystadenoma,1 case with retroperitoneal liposarcoma.Univariate analysis using pearson＆#39;s x2 test,multivariate analysis using binary Logistic regression analysis,correlation analysis using Spearman rank correlation analysis and the predictive value of pancreatic fibrosis in pancreatic fistula after pancreaticoduodenectomy was assessed using the area under the receiver operating characteristic （ROC） curve.Results There were 123 cases （30.1%） with postoperative pancreatic fistula among 408 patients.Univariate analysis showed that body mass index （BMI） （P =0.005）,preoperative gammaglutamyltranspeptidase content（P =0.046）,pancreatic duct diameter （P =0.001）,CT value of pancreatic tissue （P =0.049）,operation time （P =0.037）,pancreatic stiffness （intraoperative judgment） （P =0.001） and percentage of pancreatic fibrosis （P =0.034） were the prognostic factors of pancreatic fistula.Multivariate analysis showed that BMI ≥ 25 kg/m2,pancreatic duct diameter ≤ 3 mm,pancreatic tissue CT value 〈40 Hu,pancreatic hardness （intraoperative judgments） for the soft and pancreatic lobular fibrosis percentage ≤25% of postoperative pancreatic fistula occurrence of high-risk factor（P〈0.05）.Pancreatic fistula＆#39;s CT value and percentage of pancreatic fibrosis were significantly lower than non-pancreatic fistula group,the difference was statistically significant （P 〈 0.05）.There were significant differences in CT value and pancreatic lobular fibrosis among different grades of pancreatic fistulae（P〈0.05）.Pancreatic fistula severity was negatively correlated with the CT value of pancreatic body and the percentage of fibrosis of the pancreas （P=0.005,0.019）,and there was a significant correlation between CT value of pancreatic body and the percentage of fibrosis of the pancreas （r =0.699,P =0.028）.The areas under the ROC curve of percentage of pancreatic fibrosis and CT value of the pancreatic body were 0.745 and 0.714,respectively.Both of them were moderate predictive value for pancreatic fistula after pancreaticoduodenectomy.Conclusions The degree of pancreatic fibrosis is a prognostic factor for pancreatic texture and pancreatic fistula after pancreaticoduodenectomy.CT value of pancreatic body can be used as a quantitative index of pancreatic fibrosis,and predict the prognostic of pancreatic fistula after pancreaticoduodenectomy.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2017年第5期373-377,共5页
Chinese Journal of Surgery
关键词
胰十二指肠切除术
胰腺瘘
纤维化
Pancreaticoduodenectomy
Pancreatic fistula
Fibrosis
