摘要
目的:探讨胰十二指肠切除术(pancreaticoduodenectomy，PD)后胆肠吻合口狭窄的影响因素。方法:回顾性分析2012年9月至2022年10月于解放军总医院第一医学中心肝胆胰外科医学部行PD患者的临床资料，其中男性占比58.17%，平均年龄(59.17±11.31)岁。按照PD术后是否并发胆肠吻合口狭窄将患者分为狭窄组与非狭窄组，分析相关临床指标，采用多因素Logistic回归模型分析术后并发症的相关影响因素。结果:单因素分析显示两组间年龄、性别、手术方式、术前总胆红素水平及临床相关胰瘘、术后胆瘘比例与PD术后发生吻合口狭窄显著相关(P<0.05)。多因素Logistic回归分析显示术后胆瘘(OR＝296.41，95%CI：23.56~>999.99，P<0.05)，手术时长(OR＝1.02，95%CI：1.01~1.03，P<0.05)，术后总胆红素水平(OR＝1.01，95%CI：1.00~1.02，P<0.05)，胆管扩张(OR＝0.59，95%CI：0.01~0.21，P<0.05)、胰管扩张(OR＝0.02，95%CI：0.01~0.40，P<0.05)、术后白蛋白水平(OR＝0.06，95%CI：0.45~0.78，P<0.05)与胆肠吻合口狭窄相关。结论:术后胆瘘、手术时长及术后胆红素水平是PD术后吻合口狭窄的危险因素，胆管扩张、胰管扩张及术后白蛋白水平是其保护因素。
Abstract
Objective:To investigate the factors influencing the stenosis of bile-intestinal anastomosis after pancreaticoduodenectomy.Methods:The clinical data of patients who underwent PD at the Department of Hepatobiliary and Pancreatic Surgery and Medicine of the First Medical Center of the PLA General Hospital from September 2012 to October 2022 were analyzed retrospectively, and 58.17% were male and the mean age was 59.17±11.31 years. The patients were divided into the stenosis and non-stenosis groups according to whether the PD was complicated by bile-intestinal anastomosis stenosis after surgery, the relevant clinical indexes were analyzed, and the influencing factors related to postoperative complications were analyzed by the multi-factor logistic regression model.Results:Univariate analysis showed that age, gender, surgical approach, preoperative total bilirubin level, and clinically relevant pancreatic fistula, and the proportion of postoperative biliary fistula were significantly associated with the occurrence of postoperative anastomotic stricture in PD between the two groups (P<0.05). In multifactorial logistic regression analysis showed postoperative biliary fistula (OR=296.41, 95%CI: 23.56->999.99, P<0.05), length of surgery (OR=1.02, 95%CI: 1.01-1.03, P<0.05), postoperative total bilirubin level (OR=1.01, 95%CI: 1.00-1.02, P< 0.05), bile duct dilatation (OR=0.59, 95%CI: 0.01-0.21, P<0.05), pancreatic duct dilatation (OR=0.02, 95%CI: 0.01-0.40, P< 0.05), and postoperative albumin level (OR=0.06, 95%CI: 0.45-0.78, P< 0.05) were associated with bi-lienteric anastomosis correlation of the stenosis of the mouth.Conclusion:Postoperative biliary fistula, duration of surgery, and postoperative bilirubin levels are risk factors for postoperative anastomotic stricture in PD, and bile duct dilatation, pancreatic duct dilatation, and postoperative albumin levels are protective factors.
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