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 foreign clinical studies have confirmed that early removal of abdominal drainage tube after pancreatoduodenectomy (PD) can reduce the incidence of postoperative complications such as pancreatic fistula, but there is still a lack of relevant data in China. A retrospective case control analysis was conducted to verify the early withdrawal of PD after the operation of the Southwest Hospital in the Department of hepatobiliary surgery. Whether the abdominal drainage tube can reduce the incidence of postoperative complications such as pancreatic fistula, and further explore the prediction conditions for the early postoperative pancreatic fistula. Methods Retrospective analysis of the clinical data of 430 patients with PD surgery in Southwest Hospital Department of hepatobiliary surgery which were admitted from January 2013 to October 2015, and the early postoperative pancreatic fistula (5 days after the operation). Patients with complications such as internal pancreatic fistula were excluded. The remaining patients were divided into two groups according to the removal time of abdominal drainage tube after operation: the abdominal drainage tube was removed within 5 days after operation in group A (including 5 days). The abdominal drainage tube was removed 5 days after the operation in group B, and the incidence of pancreatic fistula in the two groups was compared, and the risk factors of pancreatic fistula occurred. Single factor and multi factor analysis; in the final analysis of the factors affecting the early postoperative pancreatic fistula in 430 patients, and using the ROC curve to explore the prediction conditions for the early postoperative pancreatic fistula. Results a total of 430 patients were retrospectively analyzed, 116 patients with early pancreatic fistula after operation, 9 patients with other early complications, and the remaining 305 patients were divided into group A 9. 8 cases, B group 207 cases, A, B two groups of patients with postoperative abdominal puncture drainage, two operation and the incidence of postoperative hospital death have no significant difference (P0.05), but the A group of postoperative pancreatic fistula, abdominal infection and total complications were significantly lower than the group B patients (3.1%vs12.1%, 9.2%vs20.3%, 24.5%vs42.0%, P0.05), postoperative hospital days are also obviously shrinking. Short (13 (4-44) vs15.5 (4-44) vs15.5 (9-64), P0.05), multiple factor Logistic regression analysis showed that male, pancreatic duct diameter 3mm, external pancreatic tumor (lower segment of the common bile duct, duodenal papilla, biliary and pancreatic ampulla tumor), 5 days after removal of abdominal drainage tube as the independent risk factor for postoperative pancreatic fistula (OR=4.424,2.369,3.874,5.028, P0.05); finally, in 430 patients. The influence factors of early pancreatic fistula were analyzed, and both DFA1 and SA1 were independent factors (P=0.000,0.016), but DFA1 was better able to predict the risk of early pancreatic fistula (AUC=0.916vs0.745, P0.001). The sensitivity, specificity, positive predictive value and negative predictive value of early pancreatic fistula after DFA1494.75IU/L exclusion were determined by ROC curve analysis. 91.7%, 80.8%, 62.7%, respectively, 96.5%. conclusion for patients with no early pancreatic fistula after PD, removal of abdominal drainage tube on fifth days after operation does not increase abdominal puncture drainage, two operation and the probability of postoperative hospital death can reduce complications such as postoperative pancreatic fistula and abdominal infection; in addition, if patient DFA1494.75IU/L, it can be performed after operation. The abdominal drainage tube was removed safely for third days.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.5

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本文編號：1989681