摘要
目的分析非胰腺来源壶腹周围癌(NPPC)患者行胰十二指肠切除术后发生外科并发症的危险因素,评估并发症对患者预后的影响。方法选择2014年8月—2018年8月因NPPC在复旦大学附属中山医院行胰十二指肠切除术的148例患者,记录其一般资料、手术信息、并发症情况、生存情况。采用卡方检验进行单因素分析,选取并发症发生的危险因素;采用logistic回归进行多因素分析。采用独立样本t检验和Kaplan-Meier生存曲线分别评估并发症对术后辅助化学治疗(简称化疗)和远期生存的影响。结果148例患者中,男73例、女75例,中位年龄为63(54,68)岁,手术时间为(4.5±2.2)h,术中出血量为(180±173)mL,中位随访时间为19.9(9.9,30.0)个月。总体术后并发症发生率为69.6%(103/148),CD分级≥3级的严重并发症发生率为5.4%(8/148)。最常见的短期术后并发症为胃排空障碍(DGE,53例,35.8%)和胰瘘(35例,23.6%)。单因素分析结果显示,术前行胆道引流、手术时间≥7.5 h和术中出血量≥550 mL是术后发生严重并发症的危险因素(P值均<0.05);BMI≥19.35 kg/m 2、术前行胆道引流、手术时间≥5.25 h、胰肠吻合方式和术后发生B级及以上胰瘘为C级DGE发生的危险因素(P值均<0.05);BMI≥24.35 kg/m 2、手术时间≥5.25 h、术中出血量≥125 mL、胰肠吻合方式和主胰管直径<3 mm为B级及以上胰瘘发生的危险因素(P值均<0.05)。多因素logistic回归分析结果显示,术前行胆道引流(OR=1.689,95%CI为0.054~53.149)、手术时间(OR=0.000)、术中出血量(OR=4.677,95%CI为0.135~161.856)均不是术后严重并发症发生的独立危险因素(P值均>0.05);手术时间≥5.25 h(OR=6.689,95%CI为1.632~27.417)和B级及以上胰瘘(OR=5.819,95%CI为1.816~18.639)为DGE发生的独立危险因素(P值均<0.05);出血量≥125 mL为B级及以上胰瘘发生的独立危险因素(OR=4.665,95%CI为1.391~15.641,P=0.013)。术后有无并发症和有无严重并发症发生的患者中接受化疗者比例的差异均无统计学意义(P值=0.304、0.461),术后有无并发症、有无严重并发症发生的患者术后开始化疗时间的差异均无统计学意义(P值=0.348、0.849)。术后有无严重并发症的患者总体生存期和无复发生存期的差异均无统计学意义(P值均>0.05)。结论胰十二指肠切除术治疗NPPC安全、有效,术后总体并发症发生率虽然较高,但严重并发症并不多见,对患者术后化疗和远期预后无显著影响。
Objective To analyze the risk factors of postoperative complications and the effect of complications on prognosis in non-pancreatic periampullary carcinoma(NPPC)patients after pancreaticoduodenectomy(PD).Methods NPPC patients treated by PD from August 2014 to August 2018 were collected retrospectively.General information,operation details,complications,clinicopathologic characters and survival of patients were recorded.Chi-square test was used in univariate analysis for the risk factors of complications,and logistic regression was used for multivariate analyses.Student t-test and Kaplan-Meier method were applied to evaluate the impact of complications on adjuvant chemotherapy and long-term survival.Results A total of 148 eligible cases were enrolled in this study,including 73 male and 75 female with a median age of 63(54,68)years old.The mean operation time was(4.5±2.2)h,and intraoperative blood loss was(180±173)mL.The median follow-up duration was 19.9(9.9,30.0)months.The incidence of postoperative complications was 69.6%(103/148),and the rate of severe complications(CD classification≥3)was 5.4%(8/148).The most common short-term complications were delayed gastric emptying(DGE,53 cases,35.8%)and pancreatic fistula(35 cases,23.6%).Univariate analysis revealed that bile drainage before surgery,operation time≥7.5 h and intraoperative blood loss≥550 mL were risk factors of severe postoperative complications(all P<0.05);BMI≥19.35 kg/m 2,bile drainage before surgery,operation time≥5.25 h,methods of pancreatic-jejunal anastomosis and pancreatic fistula≥grade B were the risk factors of grade C DGE(all P<0.05);BMI≥24.35 kg/m 2,surgery time≥5.25 h,intraoperative blood loss≥125 mL,methods of pancreatic-jejunal anastomosis and diameter of main pancreatic duct<3 mm were the risk factors of pancreatic fistula≥grade B(all P<0.05).Multivariate analysis indicated that bile drainage before surgery(OR=1.689,95%CI:0.054-53.149),surgery time(OR=0.000,95%CI:not available),and intraoperative blood loss volume(OR=4.677,95%CI:0.135-161.856)were not independent risk factors of severe postoperative complications(all P>0.05);surgery time≥5.25 h(OR=6.689,95%CI:1.632-27.417)and pancreatic fistula≥grade B(OR=5.819,95%CI:1.816-18.639)were the independent risk factors of DGE(all P<0.05);blood loss≥125 mL was the independent risk factor of pancreatic fistula≥grade B(OR=4.665,95%CI:1.391-15.641,P=0.013).Neither complications nor severe ones showed significant influence on adjuvant chemotherapy(P=0.304,0.461)as well as the time to adjuvant therapy(P=0.348,0.849).No difference was found in overall survival or recurrence-free survival was found between patients with and without severe complications(all P>0.05).Conclusion PD is safe and effective for NPPC patients.Although the incidence of postoperative complications is quite high,but severe complications are rare and no significant impact is found on the adjuvant chemotherapy and long-term survival.
作者
赵过超
方圆
浦宁
王单松
靳大勇
匡天涛
吴文川
许雪峰
戎叶飞
张磊
楼文晖
ZHAO Guochao;FANG Yuan;PU Ning;WANG Dansong;JIN Dayong;KUANG Tiantao;WU Wenchuan;XU Xuefeng;RONG Yefei;ZHANG Lei;LOU Wenhui(Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《上海医学》
CAS
2021年第2期73-79,共7页
Shanghai Medical Journal
关键词
非胰腺来源壶腹周围癌
胰十二指肠切除术
并发症
胰瘘
胃排空延迟
Non-pancreatic periampullary carcinoma
Pancreaticoduodenectomy
Complication
Pancreatic fistula
Delayed gastric emptying
