Shimoda Mitsugi, Katoh Masato, Yukihiro Iso, Kita Junji, Sawada Tokihiko, Kubota Keiichi
Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan.
Am Surg. 2012 Feb;78(2):190-4.
Pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is still a severe complication and a challenging problem. The common risk factors are the soft pancreas and small pancreatic duct of the remnant pancreas. Those two risk factors were recognized during surgery. On the other hand, a preoperatively determined risk factor of PF is unclarified. We conducted a retrospective analysis of 203 patients consecutively treated by PD from April 2000 to October 2010. PF was defined according to the criteria of the International Study Group of Pancreatic Fistula. Clinical and pre- and intraoperative data were compared between PF and non-PF patients. The recommended cutoff value of body mass index (BMI) as 20 kg/m(2) was defined by receiver operating characteristic curve analysis. PF occurred in 53 (26.1%) of 203 patients. In univariate analysis, BMI and soft remnant pancreas were found to be risk factors of PF (P = 0.027, P = 0.005). In multivariate analysis, BMI and soft pancreas were also risk factors of PF (P = 0.040, P = 0.005). Patients with PF had a significantly longer hospital stay than non-PF patients (P = 0.005). High BMI and soft pancreas were significant risk factors for PF.
胰十二指肠切除术后的胰瘘（PF）仍是一种严重的并发症且是一个具有挑战性的问题。常见的危险因素是残余胰腺质地柔软和胰管细小。这两个危险因素在手术中即可识别。另一方面，术前确定的胰瘘危险因素尚不清楚。我们对2000年4月至2010年10月期间连续接受胰十二指肠切除术治疗的203例患者进行了回顾性分析。胰瘘根据国际胰瘘研究小组的标准进行定义。对发生胰瘘和未发生胰瘘的患者的临床、术前和术中数据进行了比较。通过受试者工作特征曲线分析确定体重指数（BMI）的推荐临界值为20kg/m²。203例患者中有53例（26.1%）发生了胰瘘。单因素分析发现，BMI和残余胰腺质地柔软是胰瘘的危险因素（P = 0.027，P = 0.005）。多因素分析中，BMI和胰腺质地柔软也是胰瘘的危险因素（P = 0.040，P = 0.005）。发生胰瘘的患者住院时间明显长于未发生胰瘘的患者（P = 0.005）。高BMI和胰腺质地柔软是胰瘘的重要危险因素。
