本文選題：胰十二指腸切除術(shù) + 術(shù)后胰瘺　； 參考：《第三軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：目的國外少數(shù)臨床研究證實(shí)胰十二指腸切除(PD)術(shù)后早期拔除腹腔引流管能降低術(shù)后胰瘺等并發(fā)癥發(fā)生率,但國內(nèi)尚缺乏相關(guān)資料,本研究擬通過對西南醫(yī)院肝膽外科符合條件的PD手術(shù)患者進(jìn)行回顧性病例對照分析,驗(yàn)證PD術(shù)后早期拔除腹腔引流管能否減少術(shù)后胰瘺等并發(fā)癥的發(fā)生,并進(jìn)一步探索術(shù)后早期胰瘺的預(yù)測條件。方法回顧性分析西南醫(yī)院肝膽外科2013年1月至2015年10月收治并符合納入排除標(biāo)準(zhǔn)的430例PD手術(shù)患者的臨床資料,將發(fā)生術(shù)后早期胰瘺(術(shù)后5天內(nèi)胰瘺)等并發(fā)癥的患者從中排除;剩余患者根據(jù)術(shù)后腹腔引流管拔除時(shí)間分為兩組:A組患者術(shù)后5天內(nèi)拔除腹腔引流管(包括5天),B組患者術(shù)后5天后拔除腹腔引流管,比較兩組術(shù)后胰瘺等并發(fā)癥發(fā)生情況,并對胰瘺發(fā)生的危險(xiǎn)因素進(jìn)行單因素和多因素分析;最后在430例患者中分析術(shù)后早期胰瘺的影響因素,并利用ROC曲線探索術(shù)后早期胰瘺的預(yù)測條件。結(jié)果共回顧性分析PD手術(shù)患者430例,術(shù)后發(fā)生早期胰瘺患者116例,發(fā)生其它早期并發(fā)癥患者9例,剩余305例患者分為A組98例、B組207例,A、B兩組患者在術(shù)后腹腔穿刺引流、二次手術(shù)以及術(shù)后院內(nèi)死亡的發(fā)生率上均無顯著差異(P0.05),但A組患者術(shù)后胰瘺、腹腔感染以及總并發(fā)癥發(fā)生率顯著低于B組患者(3.1%vs12.1%,9.2%vs20.3%,24.5%vs42.0%,P0.05),術(shù)后住院天數(shù)也明顯縮短(13.0(4-44)vs15.5(9-64),P0.05),多因素Logistic回歸分析顯示:男性、胰管直徑3mm、胰腺外腫瘤(膽總管下段、十二指腸乳頭部、膽胰壺腹部腫瘤)、腹腔引流管拔除時(shí)間5天為術(shù)后胰瘺的獨(dú)立危險(xiǎn)因素(OR=4.424,2.369,3.874,5.028,P0.05);最后在430例患者中分析術(shù)后早期胰瘺的影響因素,得出DFA1與SA1均為其獨(dú)立影響因素(P=0.000,0.016),但DFA1對術(shù)后早期胰瘺風(fēng)險(xiǎn)預(yù)測能力更好(AUC=0.916vs0.745,P0.001),通過ROC曲線分析最終確定DFA1494.75IU/L排除術(shù)后早期胰瘺的敏感度、特異度、陽性預(yù)測值、陰性預(yù)測值分別為91.7%、80.8%、62.7%、96.5%。結(jié)論對于PD術(shù)后無早期胰瘺的患者,術(shù)后第5天拔除腹腔引流管不會(huì)增加腹腔穿刺引流、二次手術(shù)和術(shù)后院內(nèi)死亡的概率,反而能夠減少術(shù)后胰瘺、腹腔感染等并發(fā)癥發(fā)生;此外,如果患者DFA1494.75IU/L,則可于術(shù)后第3天安全拔除腹腔引流管。
[Abstract]:Objective A few clinical studies abroad have proved that the early extubation of abdominal drainage tube after pancreaticoduodenectomy can reduce the incidence of postoperative complications such as pancreatic fistula, but there is still a lack of relevant data in China. In this study, a retrospective case-control analysis of patients undergoing PD surgery in the Department of Hepatobiliary surgery in Southwest Hospital was conducted to verify whether the early extubation of abdominal drainage tube after PD could reduce the incidence of postoperative pancreatic fistula and other complications. And to further explore the early postoperative pancreatic fistula prediction conditions. Methods the clinical data of 430 PD patients treated in Southwest Hospital from January 2013 to October 2015 were retrospectively analyzed. Patients with early postoperative pancreatic fistula (5 days after operation) and other complications were excluded. The remaining patients were divided into two groups according to the time of extubation of celiac drainage tube after operation. The patients in group A were divided into two groups: group A, and group B were divided into two groups: group A, group B, group B and group B, The risk factors of pancreatic fistula were analyzed by univariate and multivariate analysis. Finally, the influencing factors of early postoperative pancreatic fistula were analyzed in 430 patients, and the predictive conditions of early postoperative pancreatic fistula were explored by ROC curve. Results A retrospective analysis was made on 430 cases of PD operation, 116 cases of early postoperative pancreatic fistula and 9 cases of other early complications. The remaining 305 cases were divided into group A (98 cases), group B (207 cases) and group B (207 cases). There was no significant difference in the incidence of secondary operation and hospital death, but there was no significant difference in the incidence of postoperative pancreatic fistula in group A. The incidence of abdominal infection and total complications in group B was significantly lower than that in group B (3.1 vs 12.1). The incidence of abdominal infection and total complications was significantly lower than that in group B. The incidence of intraperitoneal infection and total complications was significantly lower than that in group B (P 0.05). The incidence of intraperitoneal infection and total complications was significantly lower than that in group B (3.1vs12.1and 9.2v20.3cm vs 20.3cm vs 24.5VS42.0V, P 0.05), and the postoperative hospital stay was significantly shorter than that in group B. Multivariate Logistic regression analysis showed: male, pancreatic duct diameter 3mm, extrapancreatic tumor (inferior common bile duct, duodenal papilla) The extubation time of abdominal drainage tube was the independent risk factor of postoperative pancreatic fistula for 5 days. Finally, the influencing factors of early postoperative pancreatic fistula were analyzed in 430 patients. The results showed that both DFA1 and SA1 were independent influencing factors, but DFA1 was better in predicting the risk of early postoperative pancreatic fistula. The sensitivity, specificity, positive predictive value and negative predictive value of DFA1494.75IU/L for removing early postoperative pancreatic fistula were determined by ROC curve analysis. Conclusion for the patients without early pancreatic fistula after PD, the extubation of peritoneal drainage does not increase the probability of abdominal puncture drainage, secondary operation and postoperative nosocomial death, but can reduce complications such as postoperative pancreatic fistula and intraperitoneal infection. In addition, if the patient had DFA 1494.75 IUP / L, the peritoneal drainage tube could be safely removed on the third day after operation.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 孫備;陳宏澤;;胰十二指腸切除術(shù)后腹腔引流管合理應(yīng)用[J];中國實(shí)用外科雜志;2016年08期

2 胡丙洋;冷建軍;萬濤;董家鴻;顧萬清;黃曉強(qiáng);王敬;紀(jì)文斌;陳明易;王彥斌;張文智;;511例胰十二指腸切除術(shù)患者胰瘺危險(xiǎn)因素分析[J];中華肝膽外科雜志;2015年06期

3 朱宏達(dá);馬塵超;白岳青;艾開興;;胰十二指腸切除術(shù)后腹腔并發(fā)癥發(fā)生及引流留置時(shí)間預(yù)測[J];肝膽胰外科雜志;2014年05期

4 王偉s，

本文編號(hào)：1989680