胰十二指肠切除术后胃排空延迟：国家手术质量改进计划研究。

Delayed gastric emptying after pancreaticoduodenectomy: A study of the national surgical quality improvement program.

机构信息

Department of Surgery, University of South Carolina School of Medicine- Greenville, Greenville, SC, USA; Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.

Department of Surgery, University of South Carolina School of Medicine- Greenville, Greenville, SC, USA.

出版信息

Pancreatology. 2020 Mar;20(2):205-210. doi: 10.1016/j.pan.2019.12.003. Epub 2019 Dec 16.

DOI:10.1016/j.pan.2019.12.003

PMID:31875832

Abstract

BACKGROUND

Delayed gastric emptying (DGE) remains common after pancreaticoduodenectomy (PD). Risk factors for DGE have been difficult to identify due to a lack of a standard definition. The purpose of this study was to identify factors associated with DGE using a standard definition across a national cohort of patients.

METHODS

A retrospective cohort study of patients who underwent PD from 2014 to 2016 within the ACS-NSQIP pancreatectomy-specific module was performed. Multivariable (MV) regression was used to determine perioperative risk factors for DGE.

RESULTS

Of 10,249 patients undergoing PD, 16.6% developed DGE and were older (65.3 vs. 64.3 years), more often male (62.5% vs. 51.9%), overweight/obese (66.7% vs. 61.3%), and American Society of Anesthesiologist (ASA) class 3 (80.0% vs. 76.0%). Rates of pylorus preservation (41.4% vs. 38.7%) were higher, and median operative time (373 vs. 354 min) longer. On MV analysis, age≥65 years [OR 1.26 (95%CI 1.13-1.41)], male sex [OR 1.54 (95%CI 1.38-1.72), body mass index (BMI) > 30 [OR 1.22 (95%CI 1.06-1.40)], ASA class≥3 [OR 1.24 (95%CI 1.08-1.42)], pylorus preservation [OR 1.08 (95%CI 1.02-1.14)], and longer operative time [OR 1.26 (95%CI 1.13-1.40)] remained associated with DGE. Preoperative chemotherapy was associated with decreased risk of DGE [OR 0.77 (95%CI 0.64-0.93)].

CONCLUSION

In this national, multicenter cohort of patients undergoing PD, 16.6% of patients developed DGE based on a standardized definition. Perioperative factors including age, BMI, ASA class, pylorus preservation, and operative time were associated with increased risk of DGE. Further research is warranted to identify opportunities for prevention via preoperative rehabilitation strategies and treatment.

摘要

背景

胰十二指肠切除术（PD）后仍常发生胃排空延迟（DGE）。由于缺乏标准定义，DGE 的危险因素难以确定。本研究的目的是使用全国患者队列中的标准定义来确定与 DGE 相关的因素。

方法

对 2014 年至 2016 年期间在美国外科医师学会全国外科质量改进计划胰腺切除术特定模块中接受 PD 的患者进行回顾性队列研究。多变量（MV）回归用于确定 DGE 的围手术期危险因素。

结果

在接受 PD 的 10249 例患者中，16.6%发生了 DGE，他们年龄更大（65.3 岁 vs. 64.3 岁），更多为男性（62.5% vs. 51.9%），超重/肥胖（66.7% vs. 61.3%），美国麻醉师协会（ASA）分级 3 级（80.0% vs. 76.0%）。保留幽门的比例较高（41.4% vs. 38.7%），手术时间中位数较长（373 分钟 vs. 354 分钟）。MV 分析显示，年龄≥65 岁[比值比（OR）1.26（95%置信区间 1.13-1.41）]、男性[OR 1.54（95%CI 1.38-1.72）]、体重指数（BMI）>30[OR 1.22（95%CI 1.06-1.40）]、ASA 分级≥3[OR 1.24（95%CI 1.08-1.42）]、保留幽门[OR 1.08（95%CI 1.02-1.14）]和手术时间较长[OR 1.26（95%CI 1.13-1.40）]与 DGE 相关。术前化疗与 DGE 风险降低相关[OR 0.77（95%CI 0.64-0.93）]。