目的降低远端胰腺切除术后胰漏的发生率。方法对34例患者施行远端胰腺切除时，近端稍外凸，呈“gt;”形，然后结扎主胰管，断面缝扎止血，联合应用带血管蒂胃浆肌瓣或空肠浆肌瓣与纤维蛋白胶粘合缝闭胰腺残端。结果34例患者均未发生胰漏、腹腔感染、脓肿及胰腺假性囊肿。结论带血管蒂胃、空肠浆肌瓣有利于促进胰断面愈合，联合应用纤维蛋白胶能有效地预防胰漏。
Objective To analyze the risk factors of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) and to explore the effective index of predicting POPF after DP. Methods The clinical data of 120 patients with pancreatic disease who were treated with DP in the Department of Tumor Surgery of Xuzhou Medical University from January 2010 to November 2017 were analyzed retrospectively. The influencing factors of POPF after DP were analyzed by non-conditional logistic regression. Results Of the 120 patients, 15 patients (12.5%) had clinically significant POPF, including 13 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula. The results of non-conditional logistic regression showed that, the soft pancreas and preoperative pancreatic CT value of the pancreas less than 40 Hu were the independent risk factors of POPF after DP (P<0.05). Conclusions Pancreatic texture and preoperative CT value are important factors influencing the occurrence of POPF after DP. Evaluating the preoperative CT value and intraoperative pancreatic texture can effectively predict the risk of POPF after DP.
ObjectiveTo explore effect of preoperative prognostic nutritional index (PNI) on clinically related postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) and analyze its influencing factors in order to provide a basis for clinical prediction of CR-POPF. MethodsThe clinicopathologic data of patients who successfully completed DP in the Affiliated Hospital of Xuzhou Medical University and met the inclusion and exclusion criteria of this study from January 1, 2017 to January 31, 2021 were collected retrospectively. The preoperative PNI value was calculated and the optimal cut-off value was obtained according to the receiver operative characteristic (ROC) curve. The patients were divided into low and high PNI based on the optimal cut-off value. The clinicopathologic characteristics were compared between the patients with low and high PNI and CR-POPF or not. At the same time, multivariate logistic regression was used to analyze the influencing factors of CR-POPF. ResultsA total of 143 patients who met the inclusion and exclusion criteria were included in this study. The CR-POPF occurred in 33 cases (23.08%) after DP, and the average preoperative PNI was 52.26 (39.20–65.10), the optimal cut-off value of PNI was 50.55, with 49 cases in the low PNI group and 94 cases in the high PNI group. In patient with low PNI, the proportions of patients aged ≥65 years and with CR-POPF were higher than those with high PNI (P<0.05). In the patients with CR-POPF, the proportions of patients with soft pancreatic texture and with low preoperative PIN were higher than those without CR-POPF (P<0.05). Further, the multivariate logistic regression showed that the the preoperative low PNI (OR=5.417, P<0.001) and soft pancreatic texture (OR=4.126, P=0.002) increased the risk of CR-POPF. ConclusionLow preoperative PNI and soft pancreatic texture increase risk of CR-POPF after DP, and it is necessary to preoperatively evaluate PNI status of patients.