胰体尾切除术后住院时间延长的危险因素分析:一项单中心回顾性研究
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南京医科大学第一附属医院胰腺中心,江苏 南京 210029

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R735.9

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江苏省科教能力提升工程(江苏省医学重点学科)(ZDXK202222)


Analysis of risk factors for prelonged hospital stay after distal pancreatectomy:a single ⁃ center retrospective study
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Pancreas Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029 ,China

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    摘要:

    目的:分析胰体尾切除术(distal pancreatectomy,DP)后患者住院时间延长(≥30 d)的相关因素,筛选独立危险因素, 为优化围手术期管理提供依据。方法:回顾性分析2020年1月—2024年6月单中心1 215例接受DP的患者资料,根据术后住院时间分为≥30 d组和<30 d组。采用单因素分析比较两组临床特征的差异,多因素Logistic回归模型筛选独立危险因素。结果:1 215例DP患者中术后住院时间≥30 d 80例(6.6%)。单因素分析显示,性别、年龄、肿瘤性质、改良Appleby手术、联合脏器切除、联合血管切除、海德堡三角清扫,以及胰瘘、胃排空延迟(delayed gastric emptying,DGE)、术后出血、乳糜瘘等并发症与术后住院时间延长显著相关(P均<0.05)。多因素Logistic回归分析结果显示,改良Appleby手术(OR=3.167,P=0.007)、联合脏器切除(OR=3.334,P < 0.001)、术后出血(OR=4.148,P=0.025)、DGE(OR=10.482,P < 0.001)、腹腔感染(OR=5.718,P < 0.001)、乳糜瘘(OR=2.457,P=0.022)、脓毒症(OR=13.485,P < 0.001)及术后侵袭性操作(OR=6.045,P < 0.001)是术后住院时间≥30 d的独立危险因素。结论:胰体尾切除术后住院时间延长与多种围手术期因素相关,针对高风险因素制定个体化诊疗策略并进行优化管理有助于缩短住院时间。

    Abstract:

    Objective:To analyze the factors associated with prolonged postoperative hospital stay( ≥30 days)after distal pancreatectomy(DP),identify independent risk factors,and provide a basis for optimizing perioperative management. Methods:A retrospective analysis was conducted on 1 215 patients who underwent DP at a single center from January 2020 to June 2024. Based on postoperative hospital stay,patients were divided into two groups:≥30 days(80 cases)and <30 days(1 135 cases). Univariate analysis was used to compare differences in clinical characteristics between the two groups,and multivariate logistic regression was employed to identify independent risk factors. Results:Among the 1 215 DP cases,80(6.6% )had a postoperative hospital stay ≥30 days. Univariate analysis revealed that gender,age,tumor type,modified Appleby procedure,combined organ resection,combined vascular resection,dissection of the Heidelberg triangle,as well as complications such as pancreatic fistula,delayed gastric emptying(DGE), postoperative bleeding,and chylous fistula were significantly associated with prolonged postoperative hospital stay(all P < 0.05). Multivariate logistic regression analysis demonstrated that modified Appleby procedure(OR=3.167,P=0.007),combined organ resection(OR=3.334,P < 0.001),postoperative bleeding(OR=4.148,P=0.025),DGE(OR=10.482,P < 0.001),intra - abdominal infection(OR=5.718,P < 0.001),chylous fistula(OR=2.457,P=0.022),sepsis(OR=13.485,P < 0.001),and postoperative invasive interventions(OR=6.045,P < 0.001)were independent risk factors for a hospital stay ≥30 days. Conclusion:Prolonged postoperative hospital stay(≥30 days)after DP is associated with various perioperative factors. Developing individualized diagnostic and treatment strategies targeting high-risk factors and optimizing management can help shorten the length of hospital stay.

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胡乐,陆子鹏,蒋奎荣,陈建敏.胰体尾切除术后住院时间延长的危险因素分析:一项单中心回顾性研究[J].南京医科大学学报(自然科学版),2025,45(12):1805-1809

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  • 收稿日期:2025-08-01
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  • 在线发布日期: 2025-12-13
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