Risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy and its predictive score

目的 探讨胰十二指肠切除术后胰瘘的危险因素,建立胰瘘风险预测模型并验证其准确性.方法 回顾性收集北京大学第一医院2008年1月至2015年4月连续的445例胰十二指肠切除术患者的临床资料,以3:1比例随机分为模型组和验证组.应用单因素及多因素分析筛选模型组患者术后胰瘘的风险因素,建立术后胰瘘的风险预测模型,并代入验证组验证其预测的准确性.结果 模型组334例患者中,88例术后发生胰瘘,发生率26.4％.Logistic回归多因素分析结果提示,体重指数(P＜0.01)、术前CT所示胰管直径(P =0.001)为术后胰瘘发生的独立危险因素.据此建立胰十二指肠切除术后胰瘘风险预测模型,受试者工作特征曲线(ROC)下面积为0.829(95％ CI:0.777～0.881).代入验证组拟合ROC曲线下面积为0.885(95％ CI:0.825～0.945),提示预测准确性良好.结论 体重指数和术前CT所示胰管直径与胰十二指肠切除术后发生胰瘘有相关性.本研究建立的术后胰瘘风险预测模型具有良好的预测准确性,可为术中胰腺消化道重建、术后胰瘘的防控及处置提供参考及指导.Objective To develop and test a scoring system to predict the risks of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).Methods Clinic data and postoperative complications of the 445 consecutive patients who underwent a PD procedure between January 2008 and April 2015 in Peking University First Hospital were retrospectively collected and analyzed.The patients were randomly selected to modelling and validation sets at a ratio of 3 : 1, respectively.The patient data were subjected to univariate and multivariate analysis in the modelling set of patients.A score predictive of POPF was designed and tested in the validation set.Results POPF occurred in 88 of 334 patients(26.4％) in the modelling set.The multivariate analysis showed that body mass index (BMI,P ＜ 0.01) and pancreatic duct width (P =0.001) are associated with POPF independently.A risk score to predict POPF was constructed based on these factors and successfully tested.The area under the receiver operating characteristic curve were 0.829 (95％ CI:0.777-0.881) on the modelling set and 0.885 (95％ CI:0.825-0.945) on the validation set, respectively.Conclusions BMI and pancreatic duct width were associated with POPF after PD.The preoperative assessment of a patient's risk for POPF is feasible.The present risk score is a valid tool to predict POPF in patients undergoing PD, to make the selection on anastomosis types, and to take precautions against POPF.国家自然科学基金资助项目; National Natural Science Foundation of ChinaPubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)139-435