Chen You-yi, Sun Bei, Jiang Hong-chi
Department of Pancreatic and Biliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin 150000, China.
Zhonghua Wai Ke Za Zhi. 2013 Aug;51(8):680-4.
To analyze the predisposing factors for pancreatic fistula after pancreaticoduodenectomy.
The clinical data of 323 patients undergoing pancreaticoduodenectomy from January 2007 to March 2012 were analyzed retrospectively. There were 185 male and 138 female patients, aging from 27 to 82 years. All the patients were devided into pancreatic fistula group (n = 52) and non-pancreatic fistula group (n = 271). Twenty variables, such as age, sex, primary disease, alcohol abuse, cholangitis, bilirubin, albumin, hemoglobin, operating time, blood loss, transfusion, texture of the remnant pancreas, diameter of wirsung, drainages of pancreatic duct, specialized group which potentially affect the incidence, were analyzed by t test for continuous variables and χ(2) test for discrete variables. The variables with significance (P < 0.05) were then analyzed with Logistic regression model.
Of all the 323 patients, the overall morbidity rate was 30.3% (98/323), and the mortality was 3.7% (12/323). Pancreatic fistula rate was 16.1% (52/323), 7 patients died for pancreatic fistula PF. In univariate analysis, primary disease, preoperative high bilirubin level, intraoperative blood loss and transfusion, texture of the remnant pancreas, diameter of wirsung, drainages of pancreatic duct, specialized group had significant difference between two groups (χ(2) = 4.072 to 9.008, P < 0.05). Multivariate logistic regression analysis revealed that primary disease (OR = 2.091, P = 0.001), texture of the remnant pancreas (OR = 7.715, P = 0.040), diameter of wirsung (OR = 5.405, P = 0.006), pancreatic duct stent (OR = 4.313, P = 0.001) and specialized group (OR = 6.404, P = 0.006) were independent risk factors in pancreatic fistula.
Primary disease, texture of the remnant pancreas, diameter of wirsung, pancreatic duct stent and specialized group are independent risk factors in pancreatic fistula. With the purpose of decreasing pancreatic fistula rate after PD, it is necessary to operate meticulously and precisely, place external pancreatic duct stent and establish pancreatic center or specialized group.
分析胰十二指肠切除术后胰瘘的诱发因素。
回顾性分析2007年1月至2012年3月行胰十二指肠切除术的323例患者的临床资料。男性185例，女性138例，年龄27～82岁。将所有患者分为胰瘘组（n = 52）和非胰瘘组（n = 271）。对年龄、性别、原发疾病、酗酒、胆管炎、胆红素、白蛋白、血红蛋白、手术时间、失血量、输血情况、残余胰腺质地、胰管直径、胰管引流、可能影响发病率的专业组等20个变量，连续变量采用t检验，离散变量采用χ²检验进行分析。对有统计学意义（P < 0.05）的变量再用Logistic回归模型进行分析。
323例患者中，总发病率为30.3%（98/323），死亡率为3.7%（12/323）。胰瘘发生率为16.1%（52/323），7例患者死于胰瘘。单因素分析显示，原发疾病、术前高胆红素水平、术中失血量及输血量、残余胰腺质地、胰管直径、胰管引流、专业组在两组间有显著差异（χ² = 4.072～9.008，P < 0.05）。多因素Logistic回归分析显示，原发疾病（OR = 2.091，P = 0.001）、残余胰腺质地（OR = 7.715，P = 0.040）、胰管直径（OR = 5.405，P = 0.006）、胰管支架（OR = 4.313，P = 0.001）和专业组（OR = 6.404，P = 0.006）是胰瘘的独立危险因素。
原发疾病、残余胰腺质地、胰管直径、胰管支架和专业组是胰瘘的独立危险因素。为降低胰十二指肠切除术后胰瘘发生率，需精细准确操作，放置胰管外支架，并建立胰腺中心或专业组。
