中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (11): 1300-1305.DOI: 10.19538/j.cjps.issn1005-2208.2024.11.22

• 论著 • 上一篇    下一篇

胰十二指肠切除术后发生急性胰腺炎影响因素分析

杨翼飞1，伏    旭1，汤    能1，蔡正华1，盛坚杰2，毛    谅1，仇毓东1   

  1. 1南京大学医学院附属鼓楼医院胰腺与代谢外科，江苏南京 210008；2南京中医药大学中西医结合鼓楼临床医学院胰腺与代谢外科，江苏南京 210008
  • 出版日期:2024-11-01 发布日期:2024-11-26

  • Online:2024-11-01 Published:2024-11-26

摘要： 目的    探讨胰十二指肠切除术（PD）后发生胰腺切除术后急性胰腺炎（PPAP）的影响因素。方法    采用回顾性病例对照研究方法，连续收集2022年3月至2023年8月南京大学医学院附属鼓楼医院胰腺与代谢外科收治的205例PD病人的临床资料，按PD后是否发生PPAP分为PPAP组（45例）和非PPAP组（160例）。比较两组病人术前一般临床资料、术中与术后临床资料、术后并发症发生率的差异，采用逐步向前法的logistic回归模型分析行PD病人术后发生PPAP的影响因素。结果    PD后PPAP发生率为22.0%。单因素分析结果显示，PPAP组病人年龄、男性比例、硬胰腺比例、胰管直径、胰腺癌比例低于非PPAP组，PPAP组BMI、手术时长、FRS评分高于非PPAP组，差异有统计学意义（P<0.05）。多因素分析结果显示，高龄（OR=0.957，95%CI 0.927~0.987，P=0.006）是PD病人发生PPAP的独立保护因素，胰腺质软（OR＝7.725，95%CI 2.104~28.359，P＝0.002）、手术时间长（OR=1.006，95%CI 1.002~1.010，P＝0.006）是PD病人术后发生PPAP的独立危险因素。PPAP组病人术后临床相关性胰瘘、腹腔感染发生率及术后住院时间显著高于非PPAP组，差异有统计学意义（P<0.05）。结论    低龄、胰腺质软、手术时间长是PD术后病人发生PPAP的独立危险因素。

关键词: 胰腺切除术后急性胰腺炎, 胰十二指肠切除术, 胰瘘, 腹腔感染, 术后并发症, 急性胰腺炎

Abstract: To investigate the influencing factors of post-pancreatectomy acute pancreatitis (PPAP) after pancreaticoduodenectomy (PD). Methods    The clinical data of 205 patients who had undergone PD at the Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, were collected consecutively from March 2022 to August 2023 using retrospective case-control study method. The patients were divided into the PPAP group (45 cases) and the non-PPAP group (160 cases) according to the occurrence of PPAP after PD. The differences of preoperative baseline characteristics, intraoperative and postoperative characteristics, and the rates of postoperative complications between the two groups were compared and logistic regression model with stepwise forward method was utilized to identify the influencing factors of PPAP after PD. Results  The incidence of PPAP after PD in this study was 22.0%. The results of univariate analysis showed that age, the proportion of male, ratio of hard pancreas, the diameter of the main pancreatic duct and the rate of pancreatic ductal adenocarcinoma in the PPAP group were lower than those in the non-PPAP group, and the BMI, operation duration and FRS score in the PPAP group were higher than those in the non-PPAP group, with statistical significance (P<0.05). The results of multivariate analysis showed that older age (OR=0.957, 95%CI 0.927-0.987, P=0.006) was an independent protective factor for PPAP in PD patients, and soft pancreatic texture (OR=7.725, 95%CI 2.104-28.359, P=0.002) and long surgery time (OR=1.006, 95%CI 1.002-1.010, P=0.006) were independent risk factors for PPAP after PD. The incidence of clinically relevant postoperative pancreatic fistula, abdominal infection and the duration of postoperative hospitalization were significantly higher in the PPAP group than those in the non-PPAP group, with statistical significance (P<0.05).  Conclusion    Young age, soft pancreatic texture and long surgery time were independent risk factors for the occurrence of PPAP after PD.

Key words: post-pancreatectomy acute pancreatitis, pancreaticoduodenectomy, pancreatic fistula, abdominal infection, postoperative complications, acute pancreatitis