[1]黄涛,杨美文,张雷达.早期拔除腹腔引流管减少胰十二指肠切除术后胰瘘的回顾性研究[J].第三军医大学学报,2017,39(10):1019-1024.
 Huang Tao,Yang Meiwen,Zhang Leida.Early removal of intra-abdominal drainage reduces the incidence of pancreatic fistula after pancreaticoduodenectomy[J].J Third Mil Med Univ,2017,39(10):1019-1024.
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早期拔除腹腔引流管减少胰十二指肠切除术后胰瘘的回顾性研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第10期
页码:
1019-1024
栏目:
临床医学
出版日期:
2017-05-30

文章信息/Info

Title:
Early removal of intra-abdominal drainage reduces the incidence of pancreatic fistula after pancreaticoduodenectomy
作者:
黄涛杨美文张雷达
第三军医大学西南医院全军肝胆外科研究所
Author(s):
Huang Tao Yang Meiwen Zhang Leida

Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China

关键词:
胰十二指肠切除手术胰瘘腹腔引流
Keywords:
pancreaticoduodenectomy pancreatic fistula intra-abdominal drainage
分类号:
R619; R657.5
文献标志码:
A
摘要:

目的     探讨胰十二指肠切除手术(pancreaticoduodenectomy, PD)后早期拔除腹腔引流管能否减少术后胰瘘发生。方法     回顾性分析西南医院肝胆外科2013年1月至2015年10月收治并依据纳入排除标准归入研究对象的305例PD手术患者的临床资料,按术后腹腔引流管拔除时间分为:A组,术后≤5 d拔除;B组,术后>5 d拔除。比较两组患者术后并发症等发生情况,对胰瘘发生的相关因素进行单因素和多因素分析。结果     术后胰瘘(3.1% vs 12.1%)、腹腔感染(9.2% vs 20.3%)以及总并发症(24.5% vs 42.0%)发生率A组均显著低于B组(P<0.05),术后住院时间也明显缩短[13.0(4~44)d vs 15.5(9~64)d, P<0.05]。单因素分析示:性别(P<0.05)、术前有无显性黄疸(P<0.05)、胰管直径(<3 mm vs ≥3 mm,P<0.05)、肿瘤发生部位(胰腺vs胰腺外,P<0.01)、腹腔引流管拔除时间(≤5 d  vs >5 d,P<0.05)为术后胰瘘发生的影响因素;多因素Logistic回归分析示:男性、胰管直径<3 mm、胰腺外肿瘤(胆总管远端、十二指肠乳头部、胆胰壶腹部肿瘤)、腹腔引流管拔除时间>5 d 为胰瘘发生的独立危险因素(OR=4.424, 2.369, 3.874, 5.028, P<0.05)。结论     对于PD术后早期无胰瘘发生的患者,术后5 d内拔除腹腔引流管能够显著减少术后胰瘘、腹腔感染等并发症,延长腹腔引流管留置时间会增加术后胰瘘发生率。

Abstract:

Objective      To investigate whether early removal of intra-abdominal drainage reduces the incidence of pancreatic fistula after pancreaticoduodenectomy (PD). Methods      A total of 305 patients undergoing PD in Southwest Hospital between January 2013 and October 2015 were retrospectively analyzed. Intra-abdominal drainage was removed within 5 d following PD in 98 cases (group A) and after 5 days in 207 cases (group B). The postoperative complications were compared between the 2 groups, and the risk factors associated with pancreatic fistula were evaluated using univariate and multivariate analyses. Results       Compared with those in group B, the patients in group A showed significantly lowered incidences of pancreatic fistula (3.1% vs 12.1%), abdominal infections (9.2% vs 20.3%), and overall complications (24.5% vs 42.0%) after PD (P<0.05) with also shortened postoperative hospital stay [13.0 (4~44) vs 15.5 (9~64) d, P<0.05]. Univariate analysis identified gender (P=0.031), preoperative clinical jaundice (P=0.035), pancreatic duct diameter (<3 mm vs ≥3 mm, P<0.05), tumor location (in the pancreas or not, P=0.011) and the removal time of intraabdominal drainage (within or after 5 d following PD, P=0.011) as the risk factors of pancreatic fistula; logistic regression analysis revealed that a male gender (OR=4.424), a pancreatic duct diameter <3 mm (OR=2.369), tumors in the distal bile duct, duodenum or ampulla (OR=3.874), and dwelling time of intra-abdominal drainage for over 5 d following PD  (OR=5.028) as the independent risk factors of pancreatic fistula following PD (P<0.05). Conclusion     In patients free of pancreatic fistula early after PD, removing intra-abdominal drainage within 5 d can reduce the incidences of postoperative pancreatic fistula and abdominal infections, and a delayed removal of the drainage is strongly associated with an increased risk of pancreatic fistula.

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相似文献/References:

[1]杨美文,邓永,黄涛,等.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[J].第三军医大学学报,2017,39(11):1177.
 Yang Meiwen,Deng Yong,Huang Tao,et al.High risk factors for pancreatic fistula after pancreaticoduodenectomy and predictive value of plain CT scanning in pancreatic body[J].J Third Mil Med Univ,2017,39(10):1177.

更新日期/Last Update: 2017-05-22