摘要
目的探讨胰腺癌术后发生静脉血栓栓塞症伴腹腔感染的相关危险因素。方法回顾性分析2020年3月至2024年8月在空军军医大学第一附属医院肝胆外科行胰十二指肠切除术的70例胰腺癌患者的临床资料,其中男性31例,女性39例,年龄(58.5±6.8)岁。依据术后是否发生静脉血栓栓塞症伴腹腔感染分为两组:并发症组(n=28)和非并发症组(n=42)。记录两组一般资料、实验室指标及手术相关指标,采用logistic回归模型分析胰腺癌术后静脉血栓栓塞症伴腹腔感染发生的危险因素,采用受试者工作特征(ROC)曲线评估各因素对胰腺癌术后静脉血栓栓塞症伴腹腔感染发生的预测价值。结果多因素分析结果显示,合并糖尿病(OR=1.216,95%CI:1.225~1.657,P=0.035)、发生术后胰瘘(OR=1.292,95%CI:1.095~1.829,P=0.022)、发生术后胆瘘(OR=1.239,95%CI:1.171~2.618,P=0.005)、D-二聚体高(OR=137.030,95%CI:3.214~5843.128,P=0.010)、手术时间长(OR=1.058,95%CI:1.002~1.117,P=0.042)、血清白蛋白低(OR=0.711,95%CI:0.508~0.995,P=0.046)的胰腺癌患者,术后静脉血栓栓塞症伴腹腔感染发生的风险高。ROC曲线分析显示,糖尿病、胰瘘、胆瘘、D-二聚体、手术时长、血清白蛋白及联合指标对胰腺癌术后静脉血栓栓塞症伴腹腔感染发生均具有一定的预测价值,其中联合指标评估胰腺癌术后静脉血栓栓塞症伴腹腔感染发生情况的ROC曲线下面积为0.993(95%CI:0.982~1.000),灵敏度为1.000,特异度为0.929。结论合并糖尿病、胰瘘、胆瘘、D-二聚体、手术时间长、血清白蛋白低是胰腺癌患者术后静脉血栓栓塞症伴腹腔感染发生的独立危险因素,均具有一定诊断价值,且联合指标的预测价值较高。
Objective To investigate the risk factors associated with the development of venous thromboembolism with abdominal infection following pancreatic cancer surgery.Methods A retrospective analysis was conducted on the clinical data of 70 patients with pancreatic cancer who underwent pancreaticoduodenectomy at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Air Force Medical University from March 2020 to August 2024,of which 31 were male and 39 were female,aged(58.5±6.8)years.Two groups were divided into two groups according to the occurrence of venous thromboembolism with abdominal infection in the postoperative period:the complication group(n=28)and the non-complication group(n=42).The general data,laboratory indexes and surgery-related indexes of the two groups were recorded,and logistic regression model was used to analyse the risk factors for the occurrence of venous thromboembolism with abdominal cavity infection after pancreaticoduodenectomy,and receiver operating characteristic(ROC)curve was used to assess the predictive value of the factors for the occurrence of venous thromboembolism with abdominal cavity infection after pancreatic cancer surgery.Results Multifactorial analysis showed that the combination of diabetes mellitus(OR=1.216,95%CI:1.225-1.657,P=0.035),occurrence of postoperative pancreatic fistula(OR=1.292,95%CI:1.095-1.829,P=0.022),occurrence of postoperative biliary fistula(OR=1.239,95%CI:1.171-2.618,P=0.005),high D-dimer(OR=137.030,95%CI:3.214-5843.128,P=0.010),prolonged operation time(OR=1.058,95%CI:1.002-1.117,P=0.042),and low serum albumin(OR=0.711,95%CI:0.508-0.995,P=0.046)in pancreatic cancer patients with a high risk of postoperative venous thromboembolism with the development of abdominal infection.ROC curve analysis showed that diabetes mellitus,pancreatic fistula,biliary fistula,D-dimer,duration of surgery,serum albumin,and co-prediction had certain predictive value for the occurrence of postoperative venous thromboembolism with abdominal infection after pancreatic cancer surgery,in which,the area under the curve for co-prediction in assessing the occurrence of postoperative venous thromboembolism with abdominal infection after pancreatic cancer surgery was 0.993(95%CI:0.982-1.000),with a sensitivity of 1.000 and a specificity of 0.929.Conclusion Comorbid diabetes mellitus,pancreatic fistula,biliary fistula,D-dimer,prolonged duration of surgery,and serum albumin are independent risk factors for the development of postoperative venous thromboembolism with abdominal infection in patients with pancreatic cancer,all of which have diagnostic value and a high joint predictive value.The predictive value of co-prediction is relatively high.
作者
李婷
汪建林
周苗
宋雪
杨琳
魏希乐
Li Ting;Wang Jianlin;Zhou Miao;Song Xue;Yang Lin;Wei Xile(Department of Hepatobiliary Surgery,the First Affiliated Hospital of PLA Air Force Medical University,Xi'an 710032,China)
出处
《中华肝胆外科杂志》
北大核心
2025年第2期116-120,共5页
Chinese Journal of Hepatobiliary Surgery
基金
陕西省自然科学基础研究计划(2023-JC-QN-0825)。
关键词
胰腺肿瘤
静脉血栓栓塞症
腹腔感染
危险因素
预测
Pancreatic neoplasms
Venous thromboembolism
Abdominal infection
Risk factors
Prediction
