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 04:04

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 foreign clinical studies have confirmed that early removal of abdominal drainage tube after pancreatoduodenectomy (PD) can reduce the incidence of postoperative complications such as pancreatic fistula, but there is still a lack of relevant data in China. A retrospective case control analysis was conducted to verify the early withdrawal of PD after the operation of the Southwest Hospital in the Department of hepatobiliary surgery. Whether the abdominal drainage tube can reduce the incidence of postoperative complications such as pancreatic fistula, and further explore the prediction conditions for the early postoperative pancreatic fistula. Methods Retrospective analysis of the clinical data of 430 patients with PD surgery in Southwest Hospital Department of hepatobiliary surgery which were admitted from January 2013 to October 2015, and the early postoperative pancreatic fistula (5 days after the operation). Patients with complications such as internal pancreatic fistula were excluded. The remaining patients were divided into two groups according to the removal time of abdominal drainage tube after operation: the abdominal drainage tube was removed within 5 days after operation in group A (including 5 days). The abdominal drainage tube was removed 5 days after the operation in group B, and the incidence of pancreatic fistula in the two groups was compared, and the risk factors of pancreatic fistula occurred. Single factor and multi factor analysis; in the final analysis of the factors affecting the early postoperative pancreatic fistula in 430 patients, and using the ROC curve to explore the prediction conditions for the early postoperative pancreatic fistula. Results a total of 430 patients were retrospectively analyzed, 116 patients with early pancreatic fistula after operation, 9 patients with other early complications, and the remaining 305 patients were divided into group A 9. 8 cases, B group 207 cases, A, B two groups of patients with postoperative abdominal puncture drainage, two operation and the incidence of postoperative hospital death have no significant difference (P0.05), but the A group of postoperative pancreatic fistula, abdominal infection and total complications were significantly lower than the group B patients (3.1%vs12.1%, 9.2%vs20.3%, 24.5%vs42.0%, P0.05), postoperative hospital days are also obviously shrinking. Short (13 (4-44) vs15.5 (4-44) vs15.5 (9-64), P0.05), multiple factor Logistic regression analysis showed that male, pancreatic duct diameter 3mm, external pancreatic tumor (lower segment of the common bile duct, duodenal papilla, biliary and pancreatic ampulla tumor), 5 days after removal of abdominal drainage tube as the independent risk factor for postoperative pancreatic fistula (OR=4.424,2.369,3.874,5.028, P0.05); finally, in 430 patients. The influence factors of early pancreatic fistula were analyzed, and both DFA1 and SA1 were independent factors (P=0.000,0.016), but DFA1 was better able to predict the risk of early pancreatic fistula (AUC=0.916vs0.745, P0.001). The sensitivity, specificity, positive predictive value and negative predictive value of early pancreatic fistula after DFA1494.75IU/L exclusion were determined by ROC curve analysis. 91.7%, 80.8%, 62.7%, respectively, 96.5%. conclusion for patients with no early pancreatic fistula after PD, removal of abdominal drainage tube on fifth days after operation does not increase abdominal puncture drainage, two operation and the probability of postoperative hospital death can reduce complications such as postoperative pancreatic fistula and abdominal infection; in addition, if patient DFA1494.75IU/L, it can be performed after operation. The abdominal drainage tube was removed safely for third days.
【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

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