标题：胰十二指肠切除术后发生临床胰瘘的相关危险因素分析

      作者：储伟，丁莉莉，金慧莉    复旦大学附属华山医院东院胰腺外科，上海 200120

      卷次： 2023年34卷11期

      【摘要】 目的 分析胰十二指肠切除(PD)术后发生临床胰瘘的相关危险因素。方法 回顾性分析2020年6月至2022年3月期间入住复旦大学附属华山医院东院胰腺外科的110例PD患者的临床资料，根据患者术后是否并发胰瘘分为胰瘘组32例(术后并发胰瘘)和无胰瘘组78例(术后未并发胰瘘)。比较两组患者的一般资料和影像学检查结果(腹部总脂肪、腹壁脂肪、胰腺质地)、实验室指标[术前总胆红素(TBiL)、术前白蛋白(Alb)、术前降钙素原(PCT)]的差异；采用受试者工作特征曲线(ROC)分析腹部总脂肪、腹壁脂肪、术前TBiL、术前Alb、术前PCT对术后胰瘘的预测效能；采用非条件Logistic多元逐步回归分析PD术后胰瘘的相关因素。结果 胰瘘组患者病变位于胰腺比例、腹部总脂肪、腹壁脂肪、胰腺软质地比例、术前TBiL、术前PCT水平分别为 68.75%、(305.28±69.12) cm2、(131.28±30.79) cm2、87.50%、(189.57±16.12) μmol/L、(3.14±3.14) ng/mL，明显高于非胰瘘组的 47.44%、(224.13±65.29) cm2、(81.26±20.56) cm2、51.28%、(166.38±27.23) μmol/L、(1.71±0.52) ng/mL，差异均有统计学意义(P<0.05)；胰瘘组患者术前Alb为(29.05±3.14) g/L，明显低于非胰瘘组的(35.65±2.97) g/L，差异有统计学意义(P<0.05)；经非条件Logistic多元逐步回归分析结果显示，病变位于胰腺比例、腹部总脂肪、腹壁脂肪、胰腺软质地比例、术前TBiL、术前PCT、术前Alb均为PD术后胰瘘相关因素(P<0.05)；经ROC分析结果显示，腹部总脂肪、腹壁脂肪、TBiL、Alb、PCT对应Cut-off值分别为233.96 cm2、121.79 cm2、173.7 μmol/L、32.70 g/L、3.17 ng/mL。结论 PD患者胰腺质地较软、腹部脂肪聚集、TBiL、PCT高水平及Alb低水平均为并发胰瘘的危险因素，临床应采取补充优质蛋白、控制炎症水平等应对措施，以改善患者预后。
      【关键词】 胰十二指肠切除术；胰瘘；危险因素；胰腺质地；腹部脂肪
      【中图分类号】 R656 【文献标识码】 A 【文章编号】 1003—6350（2023）11—1569—04

Analysis of related risk factors of clinical pancreatic fistula after pancreaticoduodenectomy.
CHU Wei, DING Li-li,JIN Hui-li. Department of Pancreatic Surgery, East Branch, Huashan Hospital Fudan University, Shanghai 200120, CHINA
【Abstract】 Objective To analyze the related risk factors of clinical pancreatic fistula after pancreaticoduode-nectomy (PD). Methods The clinical data of 110 patients with PD who were admitted to Department of Pancreatic Sur-gery, East Branch, Huashan Hospital Fudan University from June 2020 to March 2022 were retrospectively analyzed. Ac-cording to the absence or absence of postoperative pancreatic fistula, the patients were divided into pancreatic fistulagroup (32 cases, postoperative pancreatic fistula) and non-pancreatic fistula group (78 cases, without postoperative pan-creatic fistula). The differences in general data and imaging findings (total abdominal fat, abdominal wall fat, pancreastexture) and laboratory indicators [preoperative total bilirubin (TBiL), preoperative albumin (Alb), preoperative procalci-tonin (PCT)] were compared between the two groups of patients. Receiver operating characteristic (ROC) curve wasused to analyze the predictive efficiency of total abdominal fat, abdominal wall fat, preoperative TBiL, preoperative Alb,and preoperative PCT on postoperative pancreatic fistula, and unconditional Logistic multivariate stepwise regressionanalysis was adopted to analyze the related factors of pancreatic fistula after PD. Results The proportion of lesions locat-ed in the pancreas, total abdominal fat, abdominal wall fat, the proportion of pancreatic soft texture, preoperative TBiL,and preoperative PCT were 68.75%, (305.28±69.12) cm2, (131.28±30.79) cm2, 87.50%, (189.57±16.12) μmol/L, and(3.14±3.14) ng/mL in pancreatic fistula group, significantly higher than 47.44%, (224.13±65.29) cm2, (81.26±20.56) cm2,51.28%, (166.38±27.23) μmol/L, and (1.71±0.52) ng/mL in non-pancreatic fistula group (P<0.05). The preoperative Albwas (29.05±3.14) g/L in pancreatic fistula group, significantly lower than (35.65±2.97) g/L in non-pancreatic fistulagroup (P<0.05). Univariate analysis showed that there were statistically significant differences in the proportion of le-sions located in the pancreas, total abdominal fat, abdominal wall fat, the proportion of pancreatic soft texture, preopera-tive TBiL, preoperative PCT, and preoperative Alb between the two groups (P<0.05). Unconditional Logistic multivariatestepwise regression analysis showed that the proportion of lesions located in the pancreas, total abdominal fat, abdominalwall fat, the proportion of pancreatic soft texture, preoperative TBiL, preoperative PCT, and preoperative Alb were all relat-ed factors of pancreatic fistula after PD (P<0.05). ROC curve analysis showed that the Cut-off values of total abdominal-fat, abdominal wall fat, TBiL, Alb, and PCT were 233.96 cm2, 121.79 cm2, 173.7 μmol/L, 32.70 g/L, and 3.17 ng/mL, re-spectively. Conclusion The soft texture of pancreas, abdominal fat accumulation, high levels of TBiL and PCT, and lowlevel of Alb in patients with PD are risk factors for pancreatic fistula. Thus, it is necessary to take clinical measures such assupplementing high-quality protein and controlling the inflammation level, in order to improve the prognosis of patients.
      【Key words】 Pancreaticoduodenectomy; Pancreatic fistula; Risk factors; Pancreatic texture; Abdominal fat