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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (02) : 145 -150. doi: 10.3877/cma.j.issn.2095-3232.2024.02.005

临床研究

保留十二指肠、胆总管、Oddi括约肌的胰头整块全切除术后并发症分析
谭明达1, 颜军1, 郭诗翔1,†()   
  1. 1. 400016　重庆医科大学；400714　中国科学院重庆绿色智能技术研究院；400714　中国科学院大学重庆学院；401147　重庆市人民医院肝胆胰腺外科研究所
  • 收稿日期:2023-12-27 出版日期:2024-04-10
  • 通信作者: 郭诗翔
  • 基金资助:
    国家自然科学基金(82373128); 重庆英才计划-青年拔尖人才"包干制"项目(cstc2022ycjh-bgzxm0137); 重庆市渝中区自然科学基金(20210160)

Analysis of complications after duodenum, common bile duct and sphincter of Oddi-preserving pancreatic head total resection

Mingda Tan1, Jun Yan1, Shixiang Guo1,†()   

  1. 1. Chongqing Medical University, Chongqing 400016, China; Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China; Chongqing School, University of Chinese Academy of Sciences, Chongqing 400714, China; Institute of Hepatobiliary and Pancreatic Surgery, Chongqing General Hospital, Chongqing 401147, China
  • Received:2023-12-27 Published:2024-04-10
  • Corresponding author: Shixiang Guo
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谭明达, 颜军, 郭诗翔. 保留十二指肠、胆总管、Oddi括约肌的胰头整块全切除术后并发症分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 145-150.

Mingda Tan, Jun Yan, Shixiang Guo. Analysis of complications after duodenum, common bile duct and sphincter of Oddi-preserving pancreatic head total resection[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(02): 145-150.

目的

探讨保留十二指肠、胆总管、Oddi括约肌的胰头整块全切除术（DCOPPHTR）术后并发症发生情况及其影响因素。

方法

回顾性分析2020年6月至2022年11月在重庆市人民医院行DCOPPHTR的32例胰腺肿瘤患者临床资料。其中男19例，女13例；平均年龄（44±16）岁。患者均签署知情同意书，符合医学伦理学规定。根据有无术后并发症分为并发症组（12例）与无并发症组（20例），分析术后并发症发生的影响因素；同时检索保留十二指肠胰头切除术相关文献，分析术后并发症发生率。并发症影响因素分析采用Logistic多因素回归分析。

结果

患者均顺利完成手术。手术时间（469±81）min，术中出血量（195±120）ml。术后发生并发症12例，其中胰瘘6例，胆漏1例，术后出血2例，腹腔感染2例，胃排空障碍1例。根据并发症Clavien-Dindo系统分级，Ⅰ级7例，Ⅱ级1例，Ⅲa级4例，无Ⅲb、Ⅳ、Ⅴ级并发症。并发症组术前主胰管直径（6±3）mm，明显小于无并发症组的（9±4）mm（t=-2.070，P<0.05）；住院时间为（31±10）d，明显长于无并发症组的（17±5）d（t=4.551，P<0.05）。Logistic多因素回归分析提示术前主胰管直径（OR=0.74，95%CI：0.56～0.99）、手术时间（OR=1.01，95%CI：1.00～1.03）是胰腺肿瘤患者DCOPPHTR术后并发症发生的独立影响因素（P<0.05）。

结论

DCOPPHTR是治疗胰头部炎性肿块及良性或低度恶性肿瘤的理想手术方式，术前主胰管直径、手术时间是胰腺肿瘤患者DCOPPHTR术后并发症发生的独立影响因素。

关键词: 保留十二指肠、胆总管、Oddi括约肌的胰头整块全切除术（DCOPPHTR）, 保留十二指肠胰头切除术（DPPHR）, 胰腺炎，慢性, 胰腺肿瘤, 手术后并发症, 危险因素
Objective

To investigate the incidence of postoperative complications and influencing factors after duodenum, common bile duct and sphincter of Oddi-preserving pancreatic head total resection (DCOPPHTR).

Methods

Clinical data of 32 patients with pancreatic tumors who underwent DCOPPHTR in Chongqing General Hospital from June 2020 to November 2022 were retrospectively analyzed. Among them,19 patients were male and 13 female, aged (44±16) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the incidence of postoperative complications, all patients were divided into the complication (n=12) and non-complication groups (n=20). The influencing factors of postoperative complications were analyzed. Studies related to DCOPPHTR were retrieved. The incidence of postoperative complications was analyzed. The risk factors of complications were identified by multivariate Logistic regression analysis.

Results

All patients successfully completed DCOPPHTR. The operation time was (469±81) min, and intraoperative blood loss was (195±120) ml.Postoperative complications occurred in 12 patients, including pancreatic fistula in 6, bile leakage in 1, postoperative bleeding in 2, abdominal infection in 2 and delayed gastric emptying in 1, respectively. According to Clavien-Dindo classification system, 7 patients developed gradeⅠcomplications, 1 case of grade Ⅱand 4 cases of grade Ⅲa. No grade Ⅲb, Ⅳand Ⅴcomplications were reported. In the complication group, preoperative diameter of main pancreatic duct was (6±3) mm, significantly shorter than (9±4) mm in thenon-complication group (t=-2.070, P<0.05). In the complication group, the length of hospital stay was (31±10) d, significantly longer than (17±5) d in the non-complication group (t=4.551, P<0.05). Multivariate Logistic regression analysis indicated that preoperative diameter of main pancreatic duct (OR=0.74, 95%CI: 0.56-0.99) and operation time (OR=1.01, 95%CI: 1.00-1.03) were the independent influencing factors for postoperative complications of DCOPPHTR in patients with pancreatic tumors (P<0.05).

Conclusions

DCOPPHTR is an ideal surgical treatment for inflammatory masses and benign or low-grade malignant tumors in pancreatic head. Preoperative diameter of main pancreatic duct and operation time are the independent influencing factors for postoperative complications of DCOPPTR in patients with pancreatic tumors.

Key words: Duodenum-CBD-Oddi sphincter-preserving pancreatic head en bloc total resection (DCOPPHTR), Duodenum-preserving pancreatic head resection (DPPHR), Pancreatitis, chronic, Pancreatic neoplasms, Postoperative complications, Risk factors
表1 并发症组与无并发症组胰腺肿瘤患者围手术期情况比较
指标 并发症组 无并发症组 统计值 P值
性别（例）     χ2=0.09 0.926
男 7 12    
女 5 8    
年龄（岁，±s） 43±16 45±15 t=-0.428 0.672
BMI（kg/m2，±s） 22±3 21±3 t=1.101 0.280
主要症状（例）        
腹痛 7 17 χ2=2.844 0.092
恶心呕吐 1 3 χ2=0.016 0.581
腹胀 2 3 χ2=0.016 0.900
血糖异常 5 8 χ2=0.305 0.926
体重下降 3 9 χ2=1.280 0.258
腹泻 2 3 χ2=0.09 0.900
术前检查        
TB （μmol/L，±s） 12±6 11±6 t=0.404 0.689
ALP （U/L，±s） 81±23 82±24 t=-0.085 0.933
GGT （U/L，±s） 32±23 26±16 t=0.867 0.393
ALB（g/L，±s） 41±4 40±4 t=0.937 0.356
HbA1c（mmol/L，±s） 6±2 7±3 t=-0.991 0.329
主胰管直径（mm，±s） 6±3 9±4 t=-2.070 0.047
胰腺CT值（HU，±s） 41±3 42±7 t=-0.403 0.690
手术时间（min，±s） 503±82 448±76 t=1.929 0.063
术中出血量（ml，±s） 200±121 193±123 t=0.168 0.867
住院时间（d，±s） 31±10 17±5 t=4.551 <0.001
原发病（例）     - 0.063
慢性胰腺炎 7 18    
导管内乳头状黏液肿瘤 3 1    
胰腺实性假乳头状瘤 2 0    
胰腺神经内分泌肿瘤 0 1    
图1 DCOPPHTR术中注：DCOPPHTR为保留十二指肠、胆总管、Oddi括约肌的胰头整块全切除术；1为胆总管，2为主胰管，3为十二指肠乳头，4为胃十二指肠动脉，5为门静脉，6为肠系膜上静脉
表2 DPPHR-t相关文献术后并发症情况（例）
第一作者 发表年份 例数 并发症 胰瘘（A/B/C级） 胆漏/胆道狭窄 术后出血 感染 胃排空障碍 再手术
周锋[7] 2009 35 5 1 3 1 0 0 0
Lee[8] 2010 14 3 1 1 - 1 0 -
Horiguchi[9] 2010 21 4 2 1 1 - 0 -
Tsuchikawa[10] 2013 13 2 2 0 - - 0 -
Umemoto[11] 2019 13 2 0/1/0 1 - - - -
Chen[12] 2020 15 3 0/2/0 0 0 1 0 0
Cai[13] 2020 24 16 10/0/1 3 1 - 0 1
Zhou[14] 2022 30 9 0/2/0 1 2 3 1 -
Liu[15] 2023 12 14 7/2/0 1 0 3 1 0
Wu[16] 2023 31 18 0/6/1 6 5 - - -
合计   208 76 38 17 10 8 2 1
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