早期拔除腹腔引流管减少胰十二指肠切除术后胰瘘的临床研究

发布时间：2018-06-07 04:03

本文选题：胰十二指肠切除术 + 术后胰瘘　；参考：《第三军医大学》2017年硕士论文

【摘要】：目的国外少数临床研究证实胰十二指肠切除(PD)术后早期拔除腹腔引流管能降低术后胰瘘等并发症发生率,但国内尚缺乏相关资料,本研究拟通过对西南医院肝胆外科符合条件的PD手术患者进行回顾性病例对照分析,验证PD术后早期拔除腹腔引流管能否减少术后胰瘘等并发症的发生,并进一步探索术后早期胰瘘的预测条件。方法回顾性分析西南医院肝胆外科2013年1月至2015年10月收治并符合纳入排除标准的430例PD手术患者的临床资料,将发生术后早期胰瘘(术后5天内胰瘘)等并发症的患者从中排除;剩余患者根据术后腹腔引流管拔除时间分为两组:A组患者术后5天内拔除腹腔引流管(包括5天),B组患者术后5天后拔除腹腔引流管,比较两组术后胰瘘等并发症发生情况,并对胰瘘发生的危险因素进行单因素和多因素分析;最后在430例患者中分析术后早期胰瘘的影响因素,并利用ROC曲线探索术后早期胰瘘的预测条件。结果共回顾性分析PD手术患者430例,术后发生早期胰瘘患者116例,发生其它早期并发症患者9例,剩余305例患者分为A组98例、B组207例,A、B两组患者在术后腹腔穿刺引流、二次手术以及术后院内死亡的发生率上均无显著差异(P0.05),但A组患者术后胰瘘、腹腔感染以及总并发症发生率显著低于B组患者(3.1%vs12.1%,9.2%vs20.3%,24.5%vs42.0%,P0.05),术后住院天数也明显缩短(13.0(4-44)vs15.5(9-64),P0.05),多因素Logistic回归分析显示:男性、胰管直径3mm、胰腺外肿瘤(胆总管下段、十二指肠乳头部、胆胰壶腹部肿瘤)、腹腔引流管拔除时间5天为术后胰瘘的独立危险因素(OR=4.424,2.369,3.874,5.028,P0.05);最后在430例患者中分析术后早期胰瘘的影响因素,得出DFA1与SA1均为其独立影响因素(P=0.000,0.016),但DFA1对术后早期胰瘘风险预测能力更好(AUC=0.916vs0.745,P0.001),通过ROC曲线分析最终确定DFA1494.75IU/L排除术后早期胰瘘的敏感度、特异度、阳性预测值、阴性预测值分别为91.7%、80.8%、62.7%、96.5%。结论对于PD术后无早期胰瘘的患者,术后第5天拔除腹腔引流管不会增加腹腔穿刺引流、二次手术和术后院内死亡的概率,反而能够减少术后胰瘘、腹腔感染等并发症发生;此外,如果患者DFA1494.75IU/L,则可于术后第3天安全拔除腹腔引流管。
[Abstract]:Objective A few clinical studies abroad have proved that the early extubation of abdominal drainage tube after pancreaticoduodenectomy can reduce the incidence of postoperative complications such as pancreatic fistula, but there is still a lack of relevant data in China. In this study, a retrospective case-control analysis of patients undergoing PD surgery in the Department of Hepatobiliary surgery in Southwest Hospital was conducted to verify whether the early extubation of abdominal drainage tube after PD could reduce the incidence of postoperative pancreatic fistula and other complications. And to further explore the early postoperative pancreatic fistula prediction conditions. Methods the clinical data of 430 PD patients treated in Southwest Hospital from January 2013 to October 2015 were retrospectively analyzed. Patients with early postoperative pancreatic fistula (5 days after operation) and other complications were excluded. The remaining patients were divided into two groups according to the time of extubation of celiac drainage tube after operation. The patients in group A were divided into two groups: group A, and group B were divided into two groups: group A, group B, group B and group B, The risk factors of pancreatic fistula were analyzed by univariate and multivariate analysis. Finally, the influencing factors of early postoperative pancreatic fistula were analyzed in 430 patients, and the predictive conditions of early postoperative pancreatic fistula were explored by ROC curve. Results A retrospective analysis was made on 430 cases of PD operation, 116 cases of early postoperative pancreatic fistula and 9 cases of other early complications. The remaining 305 cases were divided into group A (98 cases), group B (207 cases) and group B (207 cases). There was no significant difference in the incidence of secondary operation and hospital death, but there was no significant difference in the incidence of postoperative pancreatic fistula in group A. The incidence of abdominal infection and total complications in group B was significantly lower than that in group B (3.1 vs 12.1). The incidence of abdominal infection and total complications was significantly lower than that in group B. The incidence of intraperitoneal infection and total complications was significantly lower than that in group B (P 0.05). The incidence of intraperitoneal infection and total complications was significantly lower than that in group B (3.1vs12.1and 9.2v20.3cm vs 20.3cm vs 24.5VS42.0V, P 0.05), and the postoperative hospital stay was significantly shorter than that in group B. Multivariate Logistic regression analysis showed: male, pancreatic duct diameter 3mm, extrapancreatic tumor (inferior common bile duct, duodenal papilla) The extubation time of abdominal drainage tube was the independent risk factor of postoperative pancreatic fistula for 5 days. Finally, the influencing factors of early postoperative pancreatic fistula were analyzed in 430 patients. The results showed that both DFA1 and SA1 were independent influencing factors, but DFA1 was better in predicting the risk of early postoperative pancreatic fistula. The sensitivity, specificity, positive predictive value and negative predictive value of DFA1494.75IU/L for removing early postoperative pancreatic fistula were determined by ROC curve analysis. Conclusion for the patients without early pancreatic fistula after PD, the extubation of peritoneal drainage does not increase the probability of abdominal puncture drainage, secondary operation and postoperative nosocomial death, but can reduce complications such as postoperative pancreatic fistula and intraperitoneal infection. In addition, if the patient had DFA 1494.75 IUP / L, the peritoneal drainage tube could be safely removed on the third day after operation.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.5

【参考文献】