Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, GaoTanYan Street, Chongqing, 400038, People's Republic of China.
J Gastrointest Surg. 2018 Mar;22(3):438-443. doi: 10.1007/s11605-017-3660-2. Epub 2018 Jan 12.
The objective of this study is to investigate the association between the incidence of pancreatic fistula after pancreaticoduodenectomy (PD) and the degree of pancreatic fibrosis.
Between January 2013 and December 2016, the analysis of the clinical data of 529 cases of pancreaticoduodenectomy patients of our hospital was performed in a retrospective fashion. The univariate analysis and multivariate analysis were done using the Pearson chi-squared test and binary logistic regression analysis model; correlations were analyzed by Spearman rank correlation analysis. The value of the degree of pancreatic fibrosis to predict the incidence of pancreatic fistula after pancreaticoduodenectomy was evaluated by the area under the receiver operating characteristic (ROC) curve.
The total incidence of pancreatic fistula after pancreaticoduodenectomy was 28.5% (151/529). Univariate analysis and multivariate analysis showed that BMI ≥ 25 kg/m, pancreatic duct size ≤ 3 mm, pancreatic CT value< 30, the soft texture of the pancreas (judged during the operation), and the percent of fibrosis of pancreatic lobule ≤ 25% are prognostic factors of pancreatic fistula after pancreaticoduodenectomy (P < 0.05); the pancreatic CT value and the percent of fibrosis of pancreatic lobule in pancreatic fistula group were both lower than those in non-pancreatic fistula group (P < 0.05). Results indicated that there is a negative correlation between the severity of pancreatic fistula and the pancreatic CT value or the percent of fibrosis of pancreatic lobule (r = - 0.297, - 0.342, respectively). The areas under the ROC curve of the percent of fibrosis of pancreatic lobule and the pancreatic CT value were 0.756 and 0.728, respectively.
The degree of pancreatic fibrosis is a prognostic factor which can influence the pancreatic texture and the incidence of pancreatic fistula after pancreaticoduodenectomy. The pancreatic CT value can be used as a quantitative index of the degree of pancreatic fibrosis to predict the incidence of pancreatic fistula after pancreaticoduodenectomy.
本研究旨在探讨胰十二指肠切除术后胰瘘的发生与胰腺纤维化程度的关系。
回顾性分析 2013 年 1 月至 2016 年 12 月我院 529 例胰十二指肠切除术患者的临床资料，采用 Pearson χ2 检验和二项逻辑回归分析模型进行单因素和多因素分析；采用 Spearman 秩相关分析进行相关性分析。采用受试者工作特征（ROC）曲线下面积评价胰腺纤维化程度对胰十二指肠切除术后胰瘘发生的预测价值。
胰十二指肠切除术后胰瘘总发生率为 28.5%（151/529）。单因素和多因素分析表明，BMI≥25kg/m2、胰管直径≤3mm、胰腺 CT 值<30、胰腺质地柔软（术中判断）、胰腺小叶纤维化程度≤25%是胰十二指肠切除术后胰瘘的预后因素（P<0.05）；胰瘘组胰腺 CT 值和胰腺小叶纤维化程度均低于非胰瘘组（P<0.05）。结果表明，胰瘘严重程度与胰腺 CT 值或胰腺小叶纤维化程度呈负相关（r=-0.297，-0.342）。胰腺小叶纤维化程度和胰腺 CT 值的 ROC 曲线下面积分别为 0.756 和 0.728。
胰腺纤维化程度是影响胰十二指肠切除术后胰腺质地和胰瘘发生的预后因素。胰腺 CT 值可作为胰腺纤维化程度的定量指标，预测胰十二指肠切除术后胰瘘的发生。
