胰体尾切除术后住院时间≥30 天的危险因素分析: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

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江苏省科教能力提升工程(江苏省医学重点学科,编号:ZDXK202222)


Analysis of Risk Factors for Hospital Stay ≥30 Days After Distal Pancreatectomy: A Single-Center Retrospective Study
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Jiangsu Province Capability Improvement Project through Science, Technology and Education (Jiangsu Provincial Medical Key Discipline, ZDXK202222)

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    摘要:

    摘要 目的:分析胰体尾切除术后住院时间延长(≥30天)的相关因素,筛选住院时间延长的独立危险因素,为优化围手术期管理提供依据。方法:回顾性分析2020年1月至2024年6月单中心1215例接受胰体尾切除术(Distal pancreatectomy,DP)相关信息,根据术后住院时间分为≥30天组(80例)和<30天组(1135例)。采用单因素分析比较两组的临床特征差异,多因素回归模型筛选独立危险因素。结果:1215例DP中,术后住院时间≥30天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<0.05)。多因素Logistic回归分析结果证明,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天的独立危险因素。结论:胰体尾切除术后住院时间≥30天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:

    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 1215 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 (1135 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 1215 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 (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 distal pancreatectomy is associated with various perioperative factors. Developing individualized diagnostic and treatment strategies targeting high-risk factors and optimizing management can help reduce the length of hospital stay.

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  • 收稿日期:2025-08-01
  • 最后修改日期:2025-10-02
  • 录用日期:2025-11-27
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