| 刘海艳,周 游,周莉莉,刘 娟,王 璐,邵 卓.胰十二指肠切除术后发生胰瘘的危险因素及血清降钙素原早期预测价值研究[J].,2021,(20):3862-3866 |
| 胰十二指肠切除术后发生胰瘘的危险因素及血清降钙素原早期预测价值研究 |
| Risk Factors of Pancreatic Fistula after Pancreatoduodenectomy and Early Predictive Value of Serum Procalcitonin |
| 投稿时间：2021-05-10 修订日期：2021-05-31 |
| DOI：10.13241/j.cnki.pmb.2021.20.012 |
| 中文关键词: 胰十二指肠切除术 胰瘘 危险因素 血清降钙素原 预测价值 |
| 英文关键词: Pancreatoduodenectomy Pancreatic fistula Risk factors Serum procalcitonin Predictive value |
| 基金项目:上海市自然科学基金项目（17ZR1405400） |
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| 中文摘要: |
| 摘要 目的：研究探讨胰十二指肠切除术后发生胰瘘的危险因素及血清降钙素原(PCT)早期预测胰瘘的价值。方法：选取2019年1月~2019年7月间海军军医大学第一附属医院收治的250例胰十二指肠切除术患者，患者均进行胰十二指肠切除术治疗，对患者术后进行随访观察，统计患者术后胰瘘的发生率，依据患者术后是否发生胰瘘将患者分为胰瘘组（n=77）和非胰瘘组（n=173），对两组患者术后1 d PCT水平进行检测比较。采用单因素和多因素Logistic回归分析的方法对患者的胰瘘发生的影响因素进行分析，采用受试者工作特征曲线（ROC）分析术后1 d PCT水平对胰瘘发生的早期预测价值，并计算其预测胰瘘发生的曲线下面积(AUC)、敏感度和特异性。结果：250例胰十二指肠切除术后患者中有77例患者术后出现胰瘘，胰瘘发生率为30.80%。胰瘘组与非胰瘘组患者术后1 d的PCT水平均升高，且胰瘘组高于非胰瘘组(P<0.05)。单因素分析显示，胰管直径、胰腺质地、血清胆红素水平、白蛋白水平与患者术后发生胰瘘有关(P<0.05)。经多因素Logistic回归分析发现，胰管直径＜3 mm、胰腺质软、血清胆红素水平＞170 μmol/L、白蛋白水平＜30 g/L及术后1 d PCT水平＞0.75 μg/L是患者术后胰瘘发生的独立危险因素(P<0.05)。ROC曲线显示，术后1 d 检测PCT水平预测术后胰瘘发生的AUC为0.827，敏感度为83.23%，特异度为85.71%，PCT截断值为0.75 μg/L。结论：胰十二指肠切除术患者术后有较高的胰瘘发生率，胰管直径、胰腺质地、血清胆红素水平、白蛋白水平及术后PCT水平与患者术后胰瘘的发生密切相关，术后检测PCT对于胰瘘发生有较高的预测价值。 |
| 英文摘要: |
| ABSTRACT Objective: To study the risk factors of pancreatic fistula after pancreatoduodenectomy and the early predictive value of serum procalcitonin (PCT). Methods: 250 patients with pancreatoduodenectomy in the First Affiliated Hospital of Naval Medical University from January 2019 to July 2019 were selected, all patients were treated with pancreatoduodenectomy, and the patients were followed up after operation, and the incidence rate of postoperative pancreatic fistula was counted. The patients were divided into pancreatic fistula group (n=77) and non pancreatic fistula group (n=173) according to the occurrence of pancreatic fistula after operation, and the PCT levels of the two groups were detected and compared on the 1d after operation. Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of pancreatic fistula occurrence, the receiver operating characteristic curve (ROC) was used to analyze the early predictive value of PCT on 1 d after operation, for pancreatic fistula, and the area under the curve (AUC), sensitivity and specificity were calculated. Results: Pancreatic fistula occurred in 77 of 250 patients after pancreatoduodenectomy, the incidence rate of pancreatic fistula was 30.80%. The level of PCT in pancreatic fistula group and non pancreatic fistula group was increased on 1d after operation, and the pancreatic fistula group was higher than the non pancreatic fistula group(P<0.05). Univariate analysis showed that, pancreatic duct diameter, pancreatic texture, serum bilirubin level and albumin level were associated with postoperative pancreatic fistula (P<0.05). Multivariate logistic regression analysis showed that, pancreatic duct diameter <3 mm, soft pancreas, serum bilirubin level > 170 μmol/L, albumin level <30 g/L and PCT level > 0.75 μg/L on 1d after operation were independent risk factors for postoperative pancreatic fistula (P<0.05). ROC curve showed that, the AUC of PCT on 1d after operation predicting the occurrence of postoperative pancreatic fistula was 0.827, the sensitivity was 83.23%, the specificity was 85.71%, and the cut-off value of PCT was 0.75 μg/L. Conclusion: Patients with pancreatoduodenectomy have a higher incidence of pancreatic fistula, pancreatic duct diameter, pancreatic texture, serum bilirubin level, albumin level and PCT level after operation are closely related to the pancreatic fistula occurrence, the detection of PCT after operation has a high predictive value for pancreatic fistula. |
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