论文部分内容阅读
目的:探讨PD后发生胃排空延迟(DGE)的危险因素。方法:回顾性分析2017年1月至2017年11月间海军军医大学附属长海医院收治的385例行PD患者的临床资料，其中男性235例，女性150例。根据国际胰腺外科学组对DGE的定义，将患者分为临床相关胃排空延迟组(CR-DGE组)和非临床相关胃排空延迟组(非CR-DGE组)。采用单因素分析及logistic多因素回归分析法分析PD患者术后发生CR-DGE的危险因素。结果:385例患者中78例(20.3%)术后发生DGE，其中CR-DGE组35例(9.1%)。多因素回归分析结果显示，患者的体重指数(BMI，n OR＝1.117，95%n CI 1.006～1.240，n P＝0.038)、术前血清白蛋白(n OR＝0.902，95%n CI 0.832～0.977，n P＝0.012)、主胰管直径≤3 mm(n OR＝2.397，95%n CI 1.016～5.653，n P＝0.046)、胰腺质软(n OR＝2.834，95%n CI 1.093～7.350，n P＝0.032)以及术后发生临床相关胰瘘(n OR＝4.498，95%n CI 1.768～11.441，n P＝0.002)是PD术后并发CR-DGE的独立危险因素。n 结论:较高的BMI、较低的术前血清白蛋白、主胰管直径≤3 mm、胰腺质软、术后发生胰瘘是PD患者术后发生CR-DGE的危险因素，早期应予以临床干预。“,”Objective:To investigate the risk factors for delayed gastric emptying (DGE) following pancreaticoduodenectomy (PD).Methods:Clinical data of 385 patients who underwent PD in Changhai Hospital of Navy Medical University from January 2017 to November 2017 were retrospectively analyzed, including 235 men and 150 women. According to the definition of DGE by the International Study Group of Pancreatic Surgery (ISGPS), patients were divided into-clinically irrelevant DGE (non CR-DGE) group and clinically relevant DGE(CR-DGE) group. Univariate analysis and multivariate logistic analysis were used to identify the risk factors of CR-DGE after PD.Results:Of the 385 patients, 78 cases (20.3%) developed DGE. There were 35 cases of CR-DGE (9.1%). In the multivariate analysis, BMI(n OR=1.117, 95% n CI1.006-1.240, n P=0.038), preoperative serum albumin(n OR=0.902, 95% n CI 0.832-0.977, n P=0.012), the main pancreatic duct diameter (MPD)≤3 mm(n OR=2.397, 95% n CI 1.016-5.653, n P=0.046), soft texture of pancreas(n OR=2.834, 95% n CI 1.093-7.350, n P=0.032), clinically relevant postoperative pancreatic fistula (CR-POPF)(n OR=4.498, 95% n CI 1.768-11.441, n P=0.002) were independent risk factors for CR-DGE after PD.n Conclusions:High BMI, low preoperative serum albumin, MPD ≤3 mm, soft texture of pancreas and CR-POPF after surgery were independent risk factors for CR-DGE, and early clinical interventions should be performed.