摘要
目的探讨胰十二指肠切除术(pancreaticoduodenectomy,PD)术前胆道引流病人术后胰瘘及腹腔感染的相关危险因素。方法收集2018年6月至2020年12月南京大学医学院附属鼓楼医院肝胆胰中心连续收治的86例PD术前因胆道梗阻行胆道引流的病例资料。根据术后是否出现胰瘘和腹腔感染,分为胰瘘组和非胰瘘组;感染组和非感染组;胰瘘合并感染组和对照组。分析术后胰瘘、腹腔感染、胰瘘合并腹腔感染发生的危险因素。结果(1)PD术前胆道引流,术后胰瘘的发生率为43.0%(37/86),腹腔感染的发生率为43.0%(37/86),胰瘘合并腹腔感染的发生率为29.1%(25/86)。(2)PD术前胆道引流,术后发生胰瘘的多因素分析显示:术前胆汁培养中出现肺炎克雷伯杆菌、术后第1天血清白细胞计数升高是发生胰瘘的独立危险因素,其中术后第1天血清白细胞计数的最佳截断值为10.9×10^(9)/L。(3)PD术前胆道引流,术后发生腹腔感染的多因素分析显示:术前胆汁培养中出现肺炎克雷伯杆菌、术后第1天血清白细胞计数升高是出现腹腔感染的独立危险因素,其中术后第1天血清白细胞计数的最佳截断值为15.8×10^(9)/L。(4)PD术前胆道引流,术后发生胰瘘合并腹腔感染的多因素分析显示:术前胆汁培养中出现肺炎克雷伯杆菌、术后第1天血清白细胞计数升高是出现胰瘘合并腹腔感染的独立危险因素,其中术后第1天血清白细胞计数的最佳截断值为11.0×10^(9)/L。结论PD术前胆汁培养中出现肺炎克雷伯杆菌、术后第1天血清白细胞计数升高是胆道引流病人PD术后出现胰瘘和腹腔感染的独立危险因素。
Objective To explore the risk factors of postoperative pancreatic fistula and abdominal infection after pancreaticoduodenectomy(PD)in patients with preoperative biliary drainage.Methods From June 2018 to December 2020,clinical data were reviewed for 86 consecutive patients undergoing PD after biliary drainage.They were divided into pancreas fistula and non-pancreatic fistula groups;infection and non-infection groups;pancreatic fistula with infection and control groups.The risk factors of postoperative pancreatic fistula and abdominal infection were analyzed.Results The incidence of pancreatic fistula after PD in patients with biliary drainage was 43.0%(37/86),the incidence of abdominal infection 43.0%(37/86)and the incidence of pancreatic fistula with infection 29.1%(25/86);Multivariate analysis indicated that the preoperative presence of Klebsiella pneumoniae in bile and white blood cell(WBC)count at Day 1 post-operation were independent risk factors.The cut-off value of WBC count was 10.9×10^(9)/L.Multivariate analysis revealed that the preoperative presence of K.pneumoniae in bile and WBC count at Day 1 post-operation were independent risk factors.And the cut-off value of WBC count was 15.8×10^(9)/L;Multivariate analysis showed that the preoperative presence of K.pneumoniae in bile and WBC count at Day 1 post-operation were independent risk factors.And the cut-off value of white blood cell count was 11.0×10^(9)/L.Conclusion The preoperative presence of K.pneumoniae in bile culture and WBC count at Day 1 post-operation are independent risk factors for pancreatic fistula and abdominal infection in patients with biliary drainage after PD.
作者
杨翼飞
伏旭
毛谅
仇毓东
Yang Yifei;Fu Xu;Mao Liang;Qiu Yudong(Nanjing Drum Tower Hospital,Affiliated Hospital,Nanjing University Medical School,Jiangsu Nanjing 210008,China)
出处
《腹部外科》
2021年第6期420-426,共7页
Journal of Abdominal Surgery
关键词
胆道引流
胰十二指肠切除术
胰瘘
腹腔感染
危险因素
Biliary drainage
Pancreaticoduodenectomy
Pancreatic fistula
Abdominal infection
Risk factors
