摘要
目的分析引起胰漏的可能性因素。方法前瞻性地研究了2001~2009年所有的入住内蒙古医学院第三附属医院的胰体尾切除患者的临床资料。根据国际研究小组的胰瘘分类将临床胰瘘分为B级和C级。对胰漏可能有影响的因素,包括患者自身情况、肿瘤性质、手术等因素,运用单因素和多因素进行分析。结果行胰体尾切除术患者共51例（中位年龄60岁,31~75岁）,恶性23例,良性或癌前病变28例。发生胰漏17例（33.3%）;另外3例胰周局部脓肿无法确诊胰漏。多因素分析说明,对胰腺断面的处理,手工缝合和吻合器的使用相比,前者更容易发生胰瘘（OR：41.2,95%CI：3.36~486;P=0.004）。残余胰腺体积较大也是胰漏的危险因素之一（OR：7.28,95%CI：1.14~39.0;P=0.035）。结论胰体尾切除术后有效预防胰瘘的发生仍然是个难题。残留胰腺体积大小和断面缝合技术是胰瘘的危险因素。对胰瘘的预防措施需要不断地进行临床实践和探索。
【Objective 】The aim of the current study was to analyze factors which may affect the risk of pancreatic fistula formation.【Methods】All consecutive distal pancreatectomies prospectively registered in the Third Affiliated Hospital of Inner Mongolia Medical College database from 2001 to 2009 were included.Clini-cally relevant pancreatic fistula grades B and C,defined according to the International Study Group on Pan-creatic Fistula definition were assessed.The impact of patient,tumor,and surgery-related factors on the risk of pancreatic fistula formation were assessed by univariate and multivariate analyses.【Results】A distal pan-createctomy was performed in 51 patients（median age： 60 years;range： 31~75 years）,23 of whom had malig-nant and 28 benign or premalignant disease.Pancreatic fistulas were diagnosed in 17（33.3%） of the patients.An additional three patients had a local abscess without apparent but assumed pancreatic leakage.Multivariate analysis showed that pancreatic fistulas occurred more frequently after hand suturing of the transection area versus the use of a stapler（OR： 41.2,95% CI： 3.36~486;P =0.004） and a large volume of the pancreatic remnant（greater,or equal to,34 cm3） increased the subsequent risk of pancreatic fistula（OR： 7.28,95% CI： 1.14~39.0;P =0.035）.【Conclusions】Development of pancreatic fistula after distal pancreatectomy remains a challenge.The volume of the remaining pancreas and the technique of closure of the transected pancreas were found to affect this risk,thus allowing future preventive measures to be explored and evaluated in clinical tri-als.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2011年第11期1388-1390,1393,共4页
China Journal of Modern Medicine
关键词
胰体尾切除术
胰瘘
pancreatic tail resection
pancreatic fistula
