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胰体尾切除术后胃排空延迟危险因素分析：一项单中心回顾性研究
胡乐, 陆子鹏, 郭峰, 吴峻立, 高文涛, 卫积书, 张凯, 蒋奎荣, 陈建敏
中国实用外科杂志 ›› 2026, Vol. 46 ›› Issue (3) : 376-380.
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胰体尾切除术后胃排空延迟危险因素分析：一项单中心回顾性研究
Analysis of risk factors for delayed gastric emptying after distal pancreatectomy: a single-center retrospective study
目的 探讨胰体尾切除术（DP）后胃排空延迟（DGE）的危险因素，为围手术期干预提供依据。 方法 回顾性分析2020年1月至2024年6月于江苏省人民医院（南京医科大学第一附属医院）胰腺中心接受DP的1200例病人临床资料，按国际胰腺外科研究组（ISGPS）2007年标准判定并分级DGE；采用嵌套病例-对照抽样，纳入59例DGE病人和236例同期非DGE病人。单因素分析筛选候选变量，多因素Logistic回归分析独立相关因素，结果以比值比（OR）和95%置信区间（CI）表示。 结果 DGE发生率为4.9%（59/1200），其中A级21例（35.6%）、B级22例（37.3%）、C级16例（27.1%）。单因素分析显示，术前白蛋白<40 g/L、血红蛋白<120 g/L，术中脾脏切除、联合器官切除、胃左动脉或胃左静脉离断、手术时间延长、出血增多，术后腹腔感染积液、恶性病理、肿瘤直径≥45 mm、清扫淋巴结≥14枚、腹腔穿刺引流、严重并发症（Clavien-Dindo≥Ⅲ级）与DGE相关（均P<0.05）。多因素分析显示，胃左动脉离断（OR=5.889，P<0.001）、联合器官切除（OR=4.064，P<0.001）、术后腹腔感染（OR=4.470，P=0.008）与DGE独立相关。 结论 胃左动脉离断、联合器官切除及术后腹腔感染是DP后DGE的重要风险因素；临床实践中需严格把握联合切除指征，兼顾肿瘤根治与功能保护，重视胃左动脉保护，并对术后腹腔感染实施早期识别与规范处理，以降低DGE发生风险。
Objective To investigate the risk factors for delayed gastric emptying (DGE) after distal pancreatectomy (DP) and to provide evidence for perioperative intervention. Methods The clinical data of 1200 patients who underwent DP at the Pancreatic Center, Jiangsu Province Hospital (The First Affiliated Hospital of Nanjing Medical University), between January 2020 and June 2024 were retrospectively analyzed. DGE was diagnosed and graded according to the 2007 criteria of the International Study Group of Pancreatic Surgery (ISGPS). Using nested case-control sampling, 59 patients with DGE and 236 contemporaneous patients without DGE were included. Candidate variables were screened by univariable analysis, and independent associated factors were identified by multivariable logistic regression. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results The incidence of DGE was 4.9% (59/1200), including 21 cases of grade A (35.6%), 22 of grade B (37.3%), and 16 of grade C (27.1%). Univariable analysis showed that preoperative albumin <40 g/L and hemoglobin <120 g/L; intraoperative splenectomy, combined organ resection, division of the left gastric artery or left gastric vein, prolonged operative time, and increased blood loss; and postoperative intra-abdominal infection and fluid collection, malignant pathology, tumor diameter ≥45 mm, harvested lymph nodes ≥14, abdominal puncture drainage, and severe complications (Clavien-Dindo grade ≥Ⅲ) were associated with DGE (all P<0.05). Multivariable analysis showed that division of the left gastric artery (OR=5.889, P<0.001), combined organ resection (OR=4.064, P<0.001), and postoperative intra-abdominal infection (OR=4.470, P=0.008) were independently associated with DGE. Conclusion Division of the left gastric artery, combined organ resection, and postoperative intra-abdominal infection are important risk factors for DGE after DP. In clinical practice, indications for combined resection should be strictly controlled to balance oncologic radicality with functional preservation; protection of the left gastric artery should be emphasized; and postoperative intra-abdominal infection should be identified early and managed in a standardized manner to reduce the risk of DGE.
distal pancreatectomy / delayed gastric emptying / risk factors / postoperative complications
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To identify strategies to prevent and treat delayed gastric emptying (DGE) after pancreatic surgery.
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李旭, 秦婷婷, 王敏, 等. 腹腔镜胰十二指肠切除术后临床相关胃排空延迟危险因素分析[J]. 中国实用外科杂志, 2022, 42(5):564-568.DOI:10.19538/j.cjps.issn1005-2208.2022.05.18.
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刘军, 司伟, 杨凤辉, 等. 腹腔镜胰十二指肠切除术后胃排空延迟原因分析及处理[J]. 中国实用外科杂志, 2022, 42(5):569-573.DOI:10.19538/j.cjps.issn1005-2208.2022.05.19.
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中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会.胰腺术后外科常见并发症诊治及预防的专家共识(2017)[J]. 中华外科杂志, 2017, 55(5):328-334.DOI:10.3760/cma.j.issn.0529-5815.2017.05.003.
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Delayed gastric emptying (DGE) occurs commonly following pancreaticoduodenectomy (PD), but the rate of DGE in the absence of other intra-abdominal complications is poorly understood. The objectives of this study were to define the incidence of DGE and identify risk factors for DGE in patients without pancreatic fistula or other intra-abdominal infections.Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program pancreatectomy variables to identify patients with DGE following PD without evidence of fistula or intra-abdominal infection. Multivariable models were developed to assess preoperative, intraoperative, and technical factors associated with DGE.The rate of DGE was 11.7% in 10502 cases without pancreatic fistula or intra-abdominal infection. Patients were more likely to develop DGE if age ≥75 (odds ratio [OR], 1.22; P = 0.003), male (OR, 1.29; P < 0.001), underwent pylorus-sparing PD (OR, 1.27; P = 0.004), or had a prolonged operative time (OR, 1.38 if greater than seven vs less than 5 hours; P = 0.005). Factors not associated with DGE included BMI, pathologic indication, and surgical approach.The incidence of DGE after PD is notable even in patients without other abdominal complications. Identification of patients at increased risk for DGE may aid patient counseling as well as decisions regarding surgical technique, enteral feeding access, and enhanced-recovery pathways.© 2019 Wiley Periodicals, Inc.
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Delayed gastric emptying (DGE) is a common complication after distal pancreatectomy (DP). However, its incidence and risk factors remain unclear. This meta-analysis aims to clarify the incidence and risk factors associated with DGE following DP.We conducted a systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library for studies on DGE after DP, covering publications up to July 4, 2024. Odds ratios (OR) and 95 % confidence intervals (95 %CI) were pooled using random-effects or fixed-effects models. And heterogeneity testing and bias assessment were conducted.A total of 82 studies involving 35,248 patients were included. The pooled analysis showed an incidence of DGE after DP of approximately 5.0 %. Among seven non-surgical risk factors, benign lesions as a protective factor for DGE after DP,while age over 75 was identified as potential risk factor for DGE after DP. Of the 21 surgical-related risk factors, early drain removal and laparoscopic distal pancreatectomy (LDP) were linked to a lower incidence of DGE, while factors such as hemorrhage, multivisceral resection, postoperative pancreatic fistula (POPF), portal vein resection, postoperative abscess, and wound infection were identified as potential risk factors for DGE after DP.The incidence of DGE after DP is approximately 5.0 %. Risk factors include malignancy, open distal pancreatectomy (ODP), delayed drain removal, age over 75, hemorrhage, multivisceral resection, POPF, portal vein resection, postoperative abscess, and wound infection. This meta-analysis provides valuable insights for clinical practice, especially in improving the screening and management of high-risk patients. However, further large-scale, multicenter randomized controlled trials are needed to confirm these findings.Copyright © 2025 IAP and EPC. Published by Elsevier B.V. All rights reserved.
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Delayed gastric emptying (DGE) ranks as one of the most frequent complications in pancreatic surgery. It leads to increased costs for healthcare systems, lengthened hospital stays and reduced quality of life. Data about DGE after distal pancreatectomy (DP) are scarce. The StuDoQ|Pancreas registry of the German Society of General and Visceral Surgery provided data of patients who underwent distal pancreatectomy from 1 January 2014 to 31 December 2018. The retrospective evaluation included comprehensive data: 1688 patients were enrolled; DGE occurred 160 times (9.5%); grade “A” was reported for 98 (61.3%), grade “B” for 41 (25.6%) and grade “C” for 21 (13.1%) patients. In univariate analysis pancreatic fistulas were associated with higher frequencies of intraabdominal abscesses (9.1% vs. 2%, p > 0.001), postpancreatectomy haemorrhage (8.1% vs. 3.7%, >0.001) and DGE (14.5% vs. 6%, p < 0.001). According to multivariate analysis, “abscesses with invasive therapy” (p < 0.001), “other surgical complications” (p < 0.001), prolonged “stays in ICU” (p < 0.001), lengthened duration of surgery (p < 0.001) and conventional surgery (p = 0.007) were identified as independent risk factors for DGE. Perioperative and postoperative factors were identified as risk factors for DGE. Following research should examine this highly relevant topic in a prospective, register-based manner. As there is no causal therapy for DGE, its avoidance is of major importance.
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Distal pancreatectomy (DP) accounts for 25% of all pancreatic resections. Complications following DP occur in around 40% of the cases. Our aim is to analyze short-term surgical outcomes of DP based on whether the indication for resection was benign or malignant pathology, as well as the effect of the surgical approach, open versus laparoscopic on morbidity and mortality.We studied all patients undergoing DP from the National Surgery Quality Improvement Program (NSQIP) targeted pancreatectomy participant use file from 2014 to 2016. The patients were divided into 2 groups, those who underwent DP for benign diseases (DP-B) and those who underwent DP for malignant diseases (DP-M). We performed multivariate logistic regression to evaluate the association between benign or malignant distal pancreatectomies and 30-day outcomes. We included clinically and/or statistically significant confounders into the models. We also conducted the same analysis in the subgroups of open and laparoscopic DP.Three thousand five hundred and seventy-nine patients underwent distal pancreatectomy. The most common indication for surgery was malignant disease in 1894 (53%). Thirty-day mortality occurred in 0.4% of DP-B compared to 1.3% DP-M. On multivariate analysis, no significant difference was found in mortality or in the risk of pancreatic fistula between the 2 groups. Bleeding (p = 0.002) and composite morbidity (p = 0.01) were significantly higher in the DP-M group. Among composite morbidities, thromboembolism was significantly associated with DP-M (OR 2.1, p = 0.0004) only when performed with an open approach.DP-M is associated with a significantly higher risk of post-operative bleeding, thromboembolism, and sepsis compared to DP-B but no significant increase in mortality. When further analyzing the impact of the operative approach on morbidity, there was an increased rate of post-operative thromboembolic in the DP-M group when the surgery was performed in an open manner and this increased risk was no longer statistically significant if the DP-M was performed using a minimally invasive approach.
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