腹腔镜胰十二指肠切除术治疗壶腹周围癌术后腹水的预测因素。

IF 4.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Chuan-Zhi Tang, Zhong-Jun Wu, Da-Di Peng
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引用次数: 0

摘要

背景:腹腔镜胰十二指肠切除术(LPD)越来越被接受为壶腹周围癌的切除术。然而,术后腹水(POA)经常发生在LPD后,但在腹腔镜下促进POA的潜在因素知之甚少。本研究旨在探讨LPD后POA的临床影响及其潜在的预测因素。方法:回顾2015年12月至2023年2月诊断为壶腹周围癌并行LPD的患者。根据患者是否连续3天每天腹腔引流> 500 mL分为两组,随后对胰瘘(PF)-POA和非PF-POA进行亚组分析。变量包括术前实验室检查、既往病史、手术相关因素和并发症发生率进行比较。此外,应用logistic回归分析揭示了PF-POA和非PF-POA的潜在独立危险因素。结果:38例(17.4%)患者发生POA,其中17例为PF-POA, 21例为非PF-POA。与其他组相比,B级PF-POA患者腹部感染发生率更高,住院时间更长。多因素分析显示凝血酶原时间> 14 s和主胰管直径< 3 mm是PF-POA的独立危险因素。男性、总胆红素> 34.2 μmol/L、血小板计数< 100 × 109/L为非pf - poa的独立危险因素。预测PF-POA和非PF-POA的受试者工作特征曲线下面积分别为0.682和0.786。结论:POA影响LPD恢复及术后并发症,其中PF-POA是临床上最相关的POA。凝血酶原时间延长和主胰管狭窄是PF-POA的独立危险因素;男性、总胆红素水平升高和血小板计数下降是非pf - poa的独立危险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictive factors of postoperative ascites after laparoscopic pancreaticoduodenectomy for periampullary carcinoma.

Background: Laparoscopic pancreaticoduodenectomy (LPD) has gained growing acceptance for the resection of periampullary carcinoma. However, postoperative ascites (POA) frequently occurs after LPD, yet little is known about the underlying factors that promote POA under this laparoscopic approach. This study aimed to explore the clinical influence of POA after LPD and its potential predictors.

Methods: Patients diagnosed with periampullary carcinoma who subsequently underwent LPD from December 2015 to February 2023 were reviewed. Patients were assigned to the two groups by whether daily abdominal drainage > 500 mL for at least three consecutive days, followed by subgroup analysis of pancreatic fistula (PF)-POA and non-PF-POA. Variables, including preoperative laboratory tests, past history, surgery-related factors, and incidence of complications, were compared. In addition, logistic regression analysis was applied to reveal the potential independent risk factors for PF-POA and non-PF-POA.

Results: A total of 38 patients (17.4 %) developed POA, with 17 having PF-POA and 21 having non-PF-POA. Patients with grade B PF-POA experienced a higher incidence of intra-abdominal infection, and a longer hospital stay compared with other groups. Multivariate analysis demonstrated that prothrombin time > 14 s and main pancreatic duct diameter < 3 mm were independent risk factors for PF-POA. Moreover, male sex, total bilirubin > 34.2 μmol/L and platelet count < 100 × 109/L were independent risk factors for non-PF-POA. The areas under the receiver operating characteristic curve were 0.682 and 0.786 for predicting PF-POA and non-PF-POA, respectively.

Conclusions: LPD recovery and postoperative complications are impacted by POA, where PF-POA is the most clinically relevant POA. Prolonged prothrombin time and narrowed main pancreatic duct were independent risk factors for PF-POA; male sex, elevated total bilirubin level, and decreased platelet count were independent risk factors for non-PF-POA.

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来源期刊
CiteScore
5.40
自引率
6.10%
发文量
152
审稿时长
3.0 months
期刊介绍: Hepatobiliary & Pancreatic Diseases International (HBPD INT) (ISSN 1499-3872 / CN 33-1391/R) a bimonthly journal published by First Affiliated Hospital, Zhejiang University School of Medicine, China. It publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatobiliary and pancreatic diseases. Papers cover the medical, surgical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas under the headings Liver, Biliary, Pancreas, Transplantation, Research, Special Reports, Editorials, Review Articles, Brief Communications, Clinical Summary, Clinical Images and Case Reports. It also deals with the basic sciences and experimental work. The journal is abstracted and indexed in SCI-E, IM/MEDLINE, EMBASE/EM, CA, Scopus, ScienceDirect, etc.
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