胰十二指肠切除术后胰瘘的高危因素及胰体部平扫CT值对其预测价值的分析

发布时间：2018-05-31 21:52

  本文选题：胰十二指肠切除术 + 胰瘘　； 参考：《第三军医大学学报》2017年11期

【摘要】：目的探讨胰十二指肠切除术(pancreatoduodenectomy,PD)后胰瘘的高危因素及术前胰腺体部拟切除断面平扫期CT值(以下简称胰体部CT值)对PD术后胰瘘发生风险的预测价值。方法回顾性分析西南医院肝胆外科2013年1月至2015年12月期间收治的408例住院行胰十二指肠切除术患者的完整病历资料,单因素分析采用Pearson卡方检验,多因素分析采用二分类Logistic回归分析,胰体部CT值与胰瘘之间的相关性采用简单线性相关分析,其对PD术后胰瘘的预测价值采用受试者工作特征(ROC)曲线下面积。结果 408例患者共发生胰瘘123例(30.14%),单因素分析显示BMI、术前γ-谷氨酰转肽酶、胰管直径、胰体部CT值、手术时间、胰腺质地软硬(术中判断)是PD术后胰瘘的危险因素;多因素分析显示BMI≥25 kg/m~2、胰管直径≤3 mm、胰体部CT值40 Hu、胰腺质地软(术中判断)软为PD术后胰瘘发生的独立高危因素。不同胰瘘严重程度分级患者的胰体部CT值相比较,差异有统计学意义(P0.05)。胰瘘严重程度与胰体部CT值呈负相关。胰体部CT值ROC曲线下面积为0.714,对PD术后胰瘘具有中等预测价值。结论 BMI≥25 kg/m~2、胰管直径≤3 mm、胰体部CT值40 Hu、胰腺质地软硬(术中判断)软为PD术后胰瘘发生的独立高危因素,胰体部CT值对PD术后胰瘘具有中等预测价值,可指导围手术期治疗方案。
[Abstract]:Objective to investigate the high risk factors of pancreatic fistula after pancreatoduodenectomy (PDD) and to evaluate the value of preoperative CT value (CT value of pancreatic body) in predicting the risk of pancreatic fistula after PD. Methods the complete medical records of 408 inpatients undergoing pancreaticoduodenectomy in Southwest Hospital from January 2013 to December 2015 were retrospectively analyzed. Pearson chi-square test was used for univariate analysis. The correlation between CT value of pancreatic body and pancreatic fistula was analyzed by simple linear correlation analysis. The predictive value of pancreatic fistula after PD was determined by the area under the operating characteristic curve. Results there were 123 cases with pancreatic fistula in 408 cases. Univariate analysis showed that the risk factors of pancreatic fistula were preoperative 纬 -glutamyl transpeptidase, pancreatic duct diameter, CT value of pancreatic body, operation time, soft and hard pancreas texture (judging during operation). Multivariate analysis showed that BMI 鈮，

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