微创胰十二指肠切除术后达到教科书式结局影响因素的初步探讨
Preliminary Study on Influencing Factors of Textbook Outcome After Minimally Invasive Pancreaticoduodenectomy
李龙 1李源 1齐伟峻 1邴运韬 1张利 1王行雁 1李磊 1马朝来 1原春辉 1修典荣1
作者信息
- 1. 北京大学第三医院普通外科,北京 100191
- 折叠
摘要
目的 探讨胰腺导管腺癌患者微创胰十二指肠切除术(minimal invasive pancreaticoduodenectomy,MIPD)后达到教科书式结局(textbook outcome,TO)的影响因素.方法 回顾性分析 2020 年 1 月～2022 年 12 月我院 MIPD治疗 101 例胰腺导管腺癌的临床资料,根据纳入和排除标准,最终 89 例进入本研究,其中 61 例达到 TO(TO 组),28 例未达到 TO(未达到TO组).将单因素分析 P<0.05 的变量纳入多因素 logistic 回归分析 TO 的预后因素.结果 单因素分析显示胰管扩张>3 mm、术前中性粒细胞/淋巴细胞比值(neutrophil lymphocyte ratio,NLR)、延长住院时间、术后住院时间、术后 1～3d引流液淀粉酶(drain fluld amylase,DFA)>1100 U/L差异有显著性(P<0.05).多因素logistic回归分析显示TO独立预后因素:胰管扩张>3mm(OR=7.290,95%CI:1.485～35.786,P=0.014)、术后住院时间(OR=0.862,95%CI:0.751～0.989,P=0.034)、术后第 1 天DFA>1100 U/L(OR=0.052,95%CI:0.005～0.545,P=0.014).结论 MIPD 术后患者达到 TO 与手术方式(机器人辅助胰十二指肠切除术或腹腔镜胰十二指肠切除术)无关.胰管扩张>3 mm、术后住院时间、术后第 1 天DFA>1100 U/L是胰腺导管腺癌患者 MIPD术后达到 TO的独立预后因素.
Abstract
Objective To investigate influencing factors of textbook outcome(TO)in patients with pancreatic ductal adenocarcinoma undergoing minimally invasive pancreaticoduodenectomy(MIPD).Methods A retrospective analysis was conducted on the clinical data of 101 cases of pancreatic ductal adenocarcinoma treated with MIPD in our hospital from January 2020 to December 2022.According to the inclusion and exclusion criteria,89 cases were ultimately included in this study,of which 61 cases reached TO(TO group)and 28 cases did not reach TO(non-TO group).Variables with P<0.05 in univariate analysis were included in multivariate logistic regression analysis to identify independent prognostic factors of TO.Results Univariate analysis showed that there were significant differences in pancreatic duct dilation>3 mm,preoperative neutrophil lymphocyte ratio(NLR),extended hospital stay,postoperative hospitalstay,and drain fluid amylase(DFA)>1100 U/L at1-3 d aftersurgery(P<0.05).Multivariate logistic regression analysis showed that the independent prognostic factors affecting TO were:pancreatic duct dilation>3 mm(OR=7.290,95%CI:1.485-35.786,P=0.014),postoperative hospital stay(OR=0.862,95%CI:0.751-0.989,P=0.034),and the DFA on the first postoperative day>1100 U/L(OR=0.052,95%CI:0.005-0.545,P=0.014).Conclusions The outcome of TO in patients after MIPD is not related to the surgical approach(robot assisted minimally invasive pancreaticoduodenectomy or laparoscopic pancreaticoduodenectomy).Pancreatic duct dilation>3 mm,postoperative hospital stay,and DFA on the first postoperative day>1100 U/L are independent prognostic factors of TO after MIPD in patients with pancreatic ductal adenocarcinoma.
关键词
教科书式结局/胰腺导管腺癌/微创胰十二指肠切除术/胰漏Key words
Textbook outcome/Pancreatic ductal adenocarcinoma/Minimally invasive pancreaticoduodenectomy/Pancreatic fistula引用本文复制引用
出版年
2025
NETL
NSTL
万方数据