摘要
目的探讨将胰十二指肠切除术(PD)术后B级胰瘘按严重程度分级的可行性。方法回顾性分析2012年12月至2016年6月于哈尔滨医科大学附属第一医院收治的343例行PD病人的临床资料;其中术后发生B级胰瘘72例。按B级胰瘘是否需影像学辅助介入治疗分为重度组(16例)和轻度组(56例);比较组间医疗总费用、住院时间、入重症监护(ICU)率、引流管留置时间、腹腔积液、腹腔感染、腹腔出血、胆瘘、胃排空延迟、胰瘘外其他并发症类型数及发生率、胰瘘为最严重并发症发生率、术后并发症指数(PMI)、胰瘘(ACB)等指标。结果两组间在医疗总费用(8.4万元vs. 13.2万元)、住院时间(29.0 d vs. 42.0 d)、引流管留置时间(20.5 d vs. 53.0 d)、腹腔积液发生率(41.1% vs. 87.5%)、腹腔感染发生率(10.7% vs. 43.8%)、腹腔出血发生率(7.1% vs. 56.3%)、非胰瘘并发症类型数(1种vs. 4种)、胰瘘为最严重并发症发生率(53.6% vs. 87.5%)、PMI(0.22±0.08 vs. 0.37±0.00)、胰瘘ACB(0.19±0.08 vs. 0.37±0.00)差异具有统计学意义(P均<0.05);在胆漏、胃排空延迟、入ICU率、胰瘘外其他并发症发生率上差异无统计学意义。结论在国际胰腺外科研究小组2016版胰瘘分级标准中B级胰瘘严重程度存在异质性;可分为轻度与重度;有助于为PD术后B级胰瘘精准化、个体化治疗提供参考。
Objective To discuss whether grade B pancreatic fistula after pancreaticoduodenectomy(PD) can be graded according to the severity and to provide reference for accurate evaluation and treatment. Methods The clinical data of 343 patients underwent PD surgery in the First Affiliated Hospital of Harbin Medical University from December 2012 to June 2016 were retrospectively collected;among which 72 cases followed grade B pancreatic fistula. Grade B pancreatic fistula after operation was divided into severe groups of which imaging-assisted interventional therapy was needed and mild group. The total medical cost;length of hospital stay;drainage time;ICU transfer;introperitoneal effusion;introabdominal infection;abdominal hemorrhage;biliary fistula;delayed gastric emptying;number of types and incidence of complications except pancreatic fistula;incidence of pancreatic fistula as the most serious complications;postoperative morbidity index(PMI);fistula average complication burden(ACB) were statistically analyzed between two groups. Results Univariate analysis revealed that there were significant differences between two groups in the total medical cost (84;000 yuan vs. 132;000 yuan);length of hospital stay (29.0 days vs. 42.0 days);drainage time(20.5 d vs. 53.0 d);introperitonal effusion rate(41.1% vs. 87.5%);introabdominal infection rate(10.7% vs. 43.8%);abdominal hemorrhage rate(7.1% vs. 56.3%);the number of other types of complications except pancreatic fistula(1 vs. 4);pancreatic fistula as the most serious complications(53.6% vs. 87.5%);PMI(0.22±0.08 vs. 0.37±0.00);ACB(0.19±0.08 vs. 0.37±0.00);and the P-values were less than 0.05 respectively. Conclusion The severity of grade B pancreatic fistula of ISGPS update classification is heterogeneous;which can be divided into mild and severe groups. It provides a reference for precise and individualized treatment for grade B pancreatic fistula.
作者
谭宏涛
高阅
梁美玲
郭得兴
左仲强
孙备
姜洪池
TAN Hong-tao;GAO Yue;LIANG Mei-ling(Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2019年第7期719-721,共3页
Chinese Journal of Practical Surgery
基金
黑龙江省教育厅科学技术研究项目（No.12541290）
关键词
胰十二指肠切除
胰瘘
严重程度
分级
介入治疗
pancreaticoduodenectomy
pancreatic fistula
severity
grading
interventional therapy
