胰十二指肠切除术后早期液体平衡与胰瘘相关

doi:10.3969/j.issn.1006-7795.2018.01.007

摘要/Abstract

摘要： 目的评价胰十二指肠切除术（pancreaticoduodenectomy，PD）后48 h累积液体平衡量（cumulative fluid balance postoperative 48h，FB 48 h）与术后胰瘘（postoperative pancreatic fistula，POPF）发生率的关系。方法回顾性分析首都医科大学附属北京朝阳医院外科重症加强治疗病房（surgical intensive care unit，SICU）连续收治的237例PD术后患者，收集并整理其术前、术中和术后临床资料。按照是否发生POPF将患者分为胰瘘组（POPF）和非胰瘘组（Non-POPF），采用单自变量Logistic回归模型筛选POPF的危险因素，采用多自变量Logistic回归模型去除混杂因素，最终确定POPF的危险因素。进一步根据FB 48 h将患者分为液体负平衡组（FB 48 h ≤ 0 mL·kg^-1·h^-1）、少量液体正平衡组（0 mL·kg^-1·h^-1 < FB 48 h ≤ 0.5 mL·kg^-1·h^-1）、中等量液体正平衡组（0.5 mL·kg^-1·h^-1 < FB 48 h ≤ 1 mL·kg^-1·h^-1）和大量液体正平衡组（FB 48 h>1 mL·kg^-1·h^-1）等4个亚组，分析FB 48 h与POPF之间的关系。结果 30例（12.7%）患者发生了POPF，其中B级POPF 24例（10.1%），C级POPF 6例（2.5%）。多自变量Logistic回归分析显示，性别（男性）（OR=23.917，95% CI：3.775~151.526，P=0.001）、高体质量指数（body mass index，BMI）（OR=1.313，95% CI：1.059~1.628，P=0.013）、罹患糖尿病（OR=9.120，95% CI：2.262~36.771，P=0.002）、入院时低白蛋白浓度（OR=0.876，95% CI：0.783~0.981，P=0.022）、术前高胆红素浓度（OR=1.008，95% CI：1.002~1.013，P=0.005）和FB 48 h（OR=4.870，95% CI：1.906~12.443，P=0.001）为POPF的独立危险因素。大量液体正平衡组患者C级POPF发生率显著高于少量液体正平衡组（P=0.002）和中等量液体正平衡组（P=0.002）。结论 PD术后FB 48 h是POPF的独立危险因素，FB 48 h>1 mL·kg^-1·h^-1时，C级POPF发生率显著增高。

关键词: 胰十二指肠切除术, 术后胰瘘, 液体平衡

Abstract: Objective To evaluate the association between early postoperative fluid balance(FB) and postoperative pancreatic fistula(POPF) in patients undergoing pancreaticoduodenectomy(PD).Methods A retrospective analysis of 237 consecutive patients admitted in the surgical intensive care unit(SICU) after PD was performed and the preoperative, intraoperative and postoperative clinical data were collected. The patients were divided into POPF group and Non-POPF group. Univariate Logistic regression analysis was applied to screen risk factors for POPF. A multivariate Logistic regression model was developed and included potential confounding factors. The patients were divided into 4 groups according to cumulative fluid balance postoperatively at 48 h(FB 48 h) as follows:group 1(FB 48 h ≤ 0 mL·kg^-1·h^-1), group 2(0 mL·kg^-1·h^-1 < FB 48 h ≤ 0.5 mL·kg^-1·h^-1), group 3(0.5 mL·kg^-1·h^-1 < FB 48 h ≤ 1 mL·kg^-1·h^-1) and group 4(FB 48 h>1 mL·kg^-1·h^-1). The association between FB 48 h and POPF was analyzed by Chi-square test.Results POPF occurred in 30 patients(12.6%) with grade B POPF occurred in 24 patients(10.1%), and grade C POPF occurred in 6 patients(2.5%). In multivariate Logistic regression model, sex(male)(OR=23.917, 95% CI:3.775-151.526, P=0.001), body mass index(BMI) (OR=1.313,95% CI:1.059-1.628, P=0.013), diabetes(OR=9.120, 95% CI:2.262-36.771, P=0.002), low albumin levels on admission(OR=0.876, 95% CI:0.783-0.981, P=0.022), preoperative high bilirubin level(OR=1.008, 95% CI:1.002-1.013, P=0.005) and FB 48 h(OR=4.870, 95% CI:1.906-12.443, P=0.001) were risk factors for POPF. The incidence of grade C POPF was significantly increased when FB 48 h was more than 1 mL·kg^-1·h^-1 (P=0.001).Conclusion In patients undergoing PD, FB 48 h was the independent risk factor for POPF. The incidence of grade C POPF was significantly increased when FB 48 h more than 1 mL·kg^-1·h^-1.

Key words: pancreaticoduodenectomy (PD), postoperative pancreatic fistula (POPF), fluid balance

中图分类号:

R657.5

刘薇, 张进, 赵松, 李文雄, 郑悦. 胰十二指肠切除术后早期液体平衡与胰瘘相关[J]. 首都医科大学学报, 2018, 39(1): 35-40.

Liu Wei, Zhang Jin, Zhao Song, Li Wenxiong, Zheng Yue. Early postoperative fluid balance is an independent risk factor of postoperative pancreatic fistula in pancreaticoduodenectomy[J]. Journal of Capital Medical University, 2018, 39(1): 35-40.

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