中国实用外科杂志

中国实用外科杂志

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胰十二指肠切除术后胃排空障碍危险因素分析

赵战强，王龙鑫，姜洪池，孙    备，刘    杰，武林枫，谭宏涛   

  1. 哈尔滨医科大学附属第一医院胰胆外科，黑龙江哈尔滨 150001
  • 出版日期:2016-08-01 发布日期:2016-07-27

  • Online:2016-08-01 Published:2016-07-27

摘要：

目的    分析胰十二指肠切除术（PD）后发生胃排空障碍（DGE）的危险因素。方法    回顾性分析哈尔滨医科大学附属第一医院2012年1月至2015年8月实施PD的312例病人的临床资料，对26项可能影响PD术后发生DGE的指标进行单因素及多因素Logistic回归分析。结果    312例病人中有31例（9.9%）术后发生DGE。单因素分析显示，上腹部手术史、术前血红蛋白<90 g/L、保留幽门胰十二指肠切除术（PPPD）、无空肠间布朗吻合、术后未入重症监护室（ICU）、胰瘘、术后高血糖是发生DGE的危险因素（P<0.05）。多因素Logistic回归分析显示，上腹部手术史、术前血红蛋白<90 g/L、PPPD、无空肠间布朗吻合、术后未入ICU、胰瘘、术后高血糖是DGE的独立危险因素，优势比（OR）值分别为13.991、12.145、3.831、3.128、3.463、5.361、3.048。PPPD及术后高血糖是B+C级DGE发生的独立危险因素， OR值分别为7.318、3.975。结论    术前严格把握PPPD适应证、附加空肠间布朗吻合、注重围手术期血糖控制、重视术后胰瘘的早期处理以及建立多学科综合治疗协作组（MDT）均有助于减少DGE的发生。

关键词: 胰十二指肠切除术, 胃排空障碍, 危险因素

Abstract:

Delayed gastric emptying after pancreaticoduodenectomy：A single center retrospective ananlysis of risk factors         ZHAO Zhan-qiang，WANG Long-xin，JIANG Hong-chi，et al. Department of Pancreatic and Biliary Surgery，the First Affiliated Hospital of Harbin Medical University，Harbin 150001，China
Corresponding author：TAN Hong-tao，E-mail：tanhongtao2013@163.com
Abstract    Objective    To analyze the risk factors for delayed gastric emptying(DGE) after pancreaticoduodenectomy(PD). Methods    The clinical data of patients underwent PD in the First Affiliated Hospital of Harbin Medical University from January 2012 to August 2015 were collected. The factors influencing the development of DGE following PD were statistically analyzed by univariable and multivariable logistic regression analysis. Results    The incidence of DGE was 9.9%(31/312). Univariable analysis indicated upper abdominal surgery，preoperative anemia(Hb<90 g/L)，PPPD，no Braun enteroenterostomy，no postoperative ICU stay，pancreatic fistula，postoperative hyperglycemia were risk factors for DGE. Multivariable analysis using logistic regression revealed that upper abdominal surgery，preoperative anemia(Hb<90 g/L)，PPPD，no Braun enteroenterostomy，no postoperative ICU stay，pancreatic fistula，postoperative hyperglycemia were independent risk factors(OR=13.991、12.145、3.831、3.128、3.463、5.361、3.048) for DGE. PPPD and postoperative hyperglycemia were independent risk factors of Grade B and C DGE(OR=7.318, 3.975). Conclusion  For patients underwent PD，we recommend to apply PPPD reasonably，apply additional Braun enteroenterostomy procedure，control postoperative hyperglycemia and establish a multidisciplinary team will reduce the incidence of DGE.

Key words: pancreaticoduodenectomy, delayed gastric emptying, risk factors