
胰十二指肠切除术(pancreaticoduodenectomy,PD)常用于胰头、壶腹部、远端胆管的良恶性肿瘤,手术步骤复杂,涉及脏器较多,手术时间长,术前多数患者的基础状态较差,常伴有肝功能异常、梗阻性黄疸等症状,术后并发症繁多,其中包括胰瘘、胆瘘、出血、腹腔感染、胃排空延迟、肺部并发症等[1-3]。随着医学技术的进步,术后胰瘘的发生率明显下降,但在大型的医学研究中心,其发生率仍在3%~45%[4]。术后胰瘘为其他并发症的始动因素,长时间的胰瘘会引起腹腔感染、腹腔出血等并发症,严重的会造成多器官衰竭和死亡,并常常延长患者的住院时间,增加经济及心理负担[5-6]。因此,术前预测PD术后胰瘘可以帮助外科医生对胰瘘高危患者进行干预处理,在围手术期进行个体化治疗。
术后胰瘘的危险因素有很多,包括较高的身体质量指数(BMI)、较小的主胰管直径、较软的胰腺质地、术前胰腺CT值较低、术后第1天腹腔引流液淀粉酶等[7-11],各种预测模型也不尽相同[12-16]。但大多数预测模型包括了术前、术中、术后的指标,尽管预测效能良好,但无法在手术之前识别胰瘘高危患者,很难应用这些模型在术前为患者制订治疗策略。细胞外体积(extracellular volume,ECV)分数代表血管内空间分数和细胞与血管之间的组织间隙体积分数之和,碘化造影剂可自由穿过血管内和血管外-细胞外空间[17]。ECV分数可以通过增强CT来计算,其与组织纤维化之间存在相关性,目前ECV分数在心脏及肝脏领域应用广泛[17-21]。近年来也有研究[22-23]发现其与PD术后胰瘘有着密切关系,但并未用于构建预测模型。本研究旨在应用术前易得的临床和CT指标绘制列线图,来进行胰瘘的预测。
回顾性选取北部战区总医院2019年1月—2023年10月244例行PD的患者。纳入标准:(1)术前CT和临床资料完整的患者;(2)术中探查未发现转移,且术式为PD。排除标准:(1)CT图像不清晰影响测量的患者;(2)CT提示胰腺重度萎缩或未见明确胰腺实质患者;(3)排除增强CT检查与手术治疗间隔时间超过1个月的患者。按照纳入和排除标准,排除术前CT影像学资料或临床资料缺失、CT检查与手术间隔超过1个月的患者47例,排除图像显示不清或胰腺重度萎缩患者18例,最终纳入179例患者进行分析。
所有PD手术均由经验丰富的胰腺外科主任医师操作(年手术量≥20例),手术方式中开腹手术129例,腹腔镜手术50例,消化道重建方式均为child方式,手术结束后常规于胆肠吻合口后方和胰肠吻合口周围放置2枚腹腔引流管。术前30 min及术后常规预防性使用抗生素,术后常规进行抑酸、抑酶、营养支持等对症治疗,常规复查CT及血液生化指标。依照《胰腺术后外科常见并发症诊治及预防的专家共识(2017)》[24]拔除腹部引流管。
参照国际胰腺外科研究小组(ISGPS)的标准[4],胰瘘为术后≥3 d,任何可测得的腹腔引流液淀粉酶值高于正常血淀粉酶值上限的3倍,且与临床预后相关。其中B、C级胰瘘统称为临床相关胰瘘(clinically relevant postoperative pancreatic fistula,CR-POPF)。因A级胰瘘虽有淀粉酶的升高但不影响患者预后,将其称为生化瘘。生化瘘与无胰瘘统称为非CR-POPF。
收集患者性别、年龄、糖尿病史、高血压病史、BMI、手术方式、术前是否减黄等资料。实验室指标包括:术前血细胞比容,术前血红蛋白,术前前白蛋白,术前白蛋白,术前总胆红素,术前ALT、AST、ALT与AST比值及CA19-9。CT影像学资料包括:是否存在血管侵犯、胰腺平扫期、动脉期、门静脉期、平衡期CT值,主动脉平扫期、平衡期CT值,肝脏、脾脏平扫期CT值,胰腺肝脏平扫期CT值之比,胰腺脾脏平扫期CT值之比,肾后脂肪厚度,脐周脂肪厚度,腹膜胰颈前距离,ECV分数。
所有患者术前均行腹部增强CT扫描,行增强CT检查前均禁食水6~8 h,扫描仪器为通用GE宝石光谱或飞利浦256层,扫描厚度5 mm,层间距5 mm,重建厚度1.25 mm。增强扫描经肘正中静脉注射80 mL碘帕醇增强剂,速率3.0 mL/s,后延迟扫描,动脉期、门静脉期和延迟期图像分别在注射造影剂后27、77和130 s采集。扫描结束后原始图像重建后上传至图像储存系统,发送至A-site系统进行图像分析。由2名经验丰富的外科医生回顾所有纳入研究人群的CT影像,对患者信息、实验室检查、手术结果和研究结果并不知情。2名测量人员分别测量平扫期、动脉期、门静脉期和平衡期胰腺CT值(hounsfield,Hu)。选取层面为脾静脉汇入门静脉层面,在胰腺拟切除部位,于主胰管的腹侧和背侧各勾画一个面积为1 cm2的感兴趣区域(region of interest,ROI),ROI的选取尽量避开非胰腺实质区域,最终取这2个ROI的CT值的平均值作为该期胰腺的CT值,其他时相测量方法同前。在该层面同样于腹主动脉中心处勾画一个面积为1 cm2的ROI,将其CT值作为该期腹主动脉的CT值。继续于该平面测量2次主胰管最宽处直径,取平均值作为该患者主胰管直径。如果该平面主胰管直径显示不佳,则选取临近横断面进行测量,方法同前。肝脏和脾脏CT值的测量通过在器官实质处,尽量避开血管和胆管,勾画2个面积为1 cm2的ROI,然后取平均值后作为其CT值[25-26]。连接胰颈和腹膜之间的垂直距离被称为腹膜胰颈前距离[27]。脐周脂肪厚度的测量方式为在脐部水平测量腹直肌内侧缘与皮肤之间的垂直距离。肾后脂肪厚度的测量方式为左肾静脉平面左肾背膜至后腹壁的垂直距离[28]。上述测量指标如若存在任何差异,通过2位评审人共识解决。ECV分数的计算方法:ECV(%)=(1-血细胞比容)×(ΔHu胰腺/ΔHu主动脉)×100%。其中ΔHu胰腺为平衡期胰腺CT值与平扫期胰腺CT值之差,ΔHu主动脉为平衡期主动脉CT值与平扫期主动脉CT值之差,分别代表胰腺和主动脉绝对增强。各个指标测量方法见图1。
本研究采用SPSS 26.0和R 4.2.1软件进行统计数据分析。计数资料组间比较采用χ2检验或Fisher精确概率法;计量资料如符合正态分布以
本研究共纳入179例患者,其中女63例(35.2%),男116例(64.8%),中位年龄62岁。依据CR-POPF诊断标准,59例出现CR-POPF,120例为非CR-POPF。主胰管直径≤3 mm患者120例,腹膜胰颈前距离均值为50.43 mm,ECV分数的中位数为33.0%。所有患者的基线资料见表1。
变量 | 数值 |
---|---|
性别[例(%)] | |
女 | 63(35.2) |
男 | 116(64.8) |
年龄(岁) | 62.0(56.0~69.0) |
糖尿病[例(%)] | |
否 | 141(78.8) |
是 | 38(21.2) |
高血压[例(%)] | |
否 | 125(69.8) |
是 | 54(30.2) |
BMI(kg/m2) | 23.38±3.23 |
手术方式[例(%)] | |
PD | 129(72.1) |
LPD | 50(27.9) |
术前减黄[例(%)] | |
否 | 120(67.0) |
是 | 59(33.0) |
主胰管直径[例(%)] | |
≤3 mm | 120(67.0) |
>3 mm | 59(33.0) |
CT判断血管侵犯[例(%)] | |
否 | 162(90.5) |
是 | 17(9.5) |
CR-POPF[例(%)] | |
否 | 120(67.0) |
是 | 59(33.0) |
术前血细胞比容 | 0.38(0.35~0.41) |
术前血红蛋白(g/L) | 129.00(118.00~138.00) |
术前前白蛋白(mg/L) | 170.17±55.70 |
术前白蛋白(g/L) | 37.10(34.20~39.20) |
术前总胆红素(μmol/L) | 101.30(18.50~210.10) |
ALT(U/L) | 126.19(41.81~237.50) |
AST(U/L) | 82.82(30.60~151.45) |
ALT/AST | 1.40(1.04~1.85) |
CA19-9(KU/L) | 77.12(15.83~335.60) |
胰腺平扫期CT值(Hu) | 41.10(35.05~46.13) |
胰腺动脉期CT值(Hu) | 84.80(69.50~96.33) |
胰腺静脉期CT值(Hu) | 95.95(81.33~109.95) |
胰腺平衡期CT值(Hu) | 81.05±14.73 |
脾脏平扫期CT值(Hu) | 52.65(48.83~55.30) |
肝脏平扫期CT值(Hu) | 56.20±6.61 |
主动脉平扫期CT值(Hu) | 43.30(38.35~47.50) |
主动脉平衡期CT值(Hu) | 115.70(105.55~126.35) |
胰/脾CT比值 | 0.77±0.15 |
胰/肝CT比值 | 0.72±0.15 |
肾后脂肪厚度(mm) | 8.80(4.30~15.75) |
脐周脂肪厚度(mm) | 16.55(12.40~22.71) |
腹膜胰颈前距离(mm) | 50.43±1.19 |
ECV分数 | 0.33(0.27~0.39) |
单因素分析结果,ALT/AST、主胰管直径、胰腺平衡期CT值、肾后脂肪厚度、脐周脂肪厚度、腹膜胰颈前距离、ECV分数在非CR-POPF组和CR-POP组之间的差异均有统计学意义(P值均<0.05)(表2)。将上述指标纳入多因素Logistic回归分析,结果显示,较大的ALT/AST(P=0.004)、主胰管直径≤3 mm(P=0.022)、较大的腹膜胰颈前距离(P=0.027),较小的ECV分数(P=0.005)均为术后CR-POPF的独立危险因素(表3)。
变量 | 非CR-POPF(n=120) | CR-POPF(n=59) | 统计值 | P值 |
---|---|---|---|---|
性别[例(%)] | χ2=3.680 | 0.055 | ||
女 | 48(40.0) | 15(25.4) | ||
男 | 72(60.0) | 44(74.6) | ||
年龄[例(%)] | χ2=0.574 | 0.449 | ||
≤60岁 | 56(46.7) | 24(40.7) | ||
>60岁 | 64(53.3) | 35(59.3) | ||
糖尿病[例(%)] | χ2=1.826 | 0.177 | ||
否 | 98(81.7) | 43(72.9) | ||
是 | 22(18.3) | 16(27.1) | ||
高血压[例(%)] | χ2=0.005 | 0.945 | ||
否 | 84(70.0) | 41(69.5) | ||
是 | 36(30.0) | 18(30.5) | ||
BMI[例(%)] | χ2=3.455 | 0.063 | ||
≤25 kg/m2 | 93(77.5) | 38(64.4) | ||
>25 kg/m2 | 27(22.5) | 21(35.6) | ||
手术方式[例(%)] | χ2=1.556 | 0.272 | ||
开腹 | 90(75.0) | 39(66.1) | ||
腹腔镜 | 30(25.0) | 20(33.9) | ||
术前减黄[例(%)] | χ2=0.276 | 0.599 | ||
否 | 82(68.3) | 38(64.4) | ||
是 | 38(31.7) | 21(35.6) | ||
CT判断血管侵犯[例(%)] | χ2=0.046 | 0.830 | ||
否 | 109(90.8) | 53(89.8) | ||
是 | 11(9.2) | 6(10.2) | ||
主胰管直径[例(%)] | χ2=14.992 | <0.001 | ||
≤3 mm | 69(57.5) | 51(86.4) | ||
>3 mm | 51(42.5) | 8(13.6) | ||
术前血细胞比容 | 0.37(0.35~0.41) | 0.39(0.34~0.42) | Z=-1.166 | 0.244 |
术前血红蛋白(g/L) | 126.00(118.00~134.00) | 132.00(116.00~142.00) | Z=-1.862 | 0.063 |
术前前白蛋白(mg/L) | 169.86±52.96 | 170.80±56.81 | t=-0.109 | 0.913 |
术前白蛋白(g/L) | 36.90(33.90~39.10) | 37.80(34.60~40.30) | Z=-1.047 | 0.295 |
术前总胆红素(μmol/L) | 99.50(16.82~209.93) | 112.50(34.50~221.40) | Z=-0.655 | 0.512 |
ALT(U/L) | 119.95(40.57~231.06) | 143.62(44.98~229.75) | Z=-0.331 | 0.740 |
AST(U/L) | 85.44(31.86~169.99) | 77.73(30.20~121.69) | Z=-0.902 | 0.367 |
ALT/AST | 1.27(1.00~1.68) | 1.53(1.21~2.02) | Z=-3.188 | 0.001 |
CA19-9(KU/L) | 94.82(10.39~487.13) | 53.90(25.47~257.90) | Z=-0.124 | 0.901 |
胰腺平扫期CT值(Hu) | 41.33(35.65~46.00) | 39.05(34.70~46.15) | Z=-0.813 | 0.416 |
胰腺动脉期CT值(Hu) | 84.17(68.71~95.56) | 88.00(76.25~92.00) | Z=-1.837 | 0.066 |
胰腺静脉期CT值(Hu) | 96.63(82.79~109.51) | 95.70(81.10~110.30) | Z=-0.175 | 0.861 |
胰腺平衡期CT值(Hu) | 85.90(75.13~92.95) | 71.50(67.70~79.40) | Z=-4.833 | <0.001 |
脾脏平扫期CT值(Hu) | 52.58(48.8~55.21) | 52.50(49.45~54.95) | Z=-0.075 | 0.94 |
肝脏平扫期CT值(Hu) | 56.01±6.76 | 56.59±6.33 | t=-0.546 | 0.586 |
主动脉平扫期CT值(Hu) | 42.56±7.06 | 42.15±6.48 | t=0.369 | 0.713 |
主动脉平衡期CT值(Hu) | 116.20(105.78~130.78) | 116.30(107.40~125.80) | Z=-0.074 | 0.941 |
胰/脾CT比值 | 0.80(0.67~0.89) | 0.76(0.66~0.87) | Z=-0.942 | 0.346 |
胰/肝CT比值 | 0.73±0.16 | 0.71±0.13 | t=0.978 | 0.329 |
肾后脂肪厚度(mm) | 8.24(3.80~14.51) | 11.60(6.30~16.50) | Z=-2.068 | 0.039 |
脐周脂肪厚度(mm) | 15.95(12.10~21.71) | 19.10(14.30~25.30) | Z=-2.189 | 0.029 |
腹膜胰颈前距离(mm) | 46.99±16.31 | 57.43±12.56 | t=-4.718 | <0.001 |
ECV分数 | 0.36(0.32~0.41) | 0.29(0.24~0.31) | Z=-6.045 | <0.001 |
变量 | β值 | OR(95%CI) | P值 |
---|---|---|---|
主胰管直径(≤3 mm vs >3 mm) | -1.117 | 0.276(0.105~0.725) | 0.022 |
ALT/AST | 0.798 | 2.221(1.281~3.851) | 0.004 |
胰腺平衡期CT值 | -0.008 | 0.992(0.956~1.030) | 0.691 |
肾后脂肪厚度 | -0.01 | 0.990(0.937~1.047) | 0.732 |
脐周脂肪厚度 | 0.002 | 1.002(0.956~1.050) | 0.937 |
腹膜胰颈前距离 | 0.034 | 1.034(1.004~1.066) | 0.027 |
ECV分数 | -9.126 | 0.001(0.000~0.067) | 0.005 |
利用多因素Logistic回归分析结果得出的独立危险因素构建列线图(图2),该模型展示出了良好的预测性能,C指数为0.837(0.766~0.898)。校准图提示预测模型具有一定的稳定性(图3)。进一步比较各个危险因素的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)(表4),确定列线图总评分的最佳临界值;列线图的AUC为0.837,高于各单项指标(ALT/AST:0.647、主胰管直径:0.645、腹膜胰颈前距离:0.686、ECV分数:0.778)(图4);列线图预测CR-POPF的敏感度为0.932,特异度为0.725,PPV为0.625,NPV为0.956,表明列线图具有更好的判别性能。通过决策曲线和临床影响曲线验证了该模型的临床应用价值,显示出较大的临床净收益,这进一步证明列线图具有更好的预测价值和准确性(图5)。
变量 | AUC(95%CI) | 敏感度 | 特异度 | PPV | NPV | Cut-off |
---|---|---|---|---|---|---|
ALT/AST | 0.647(0.560~0.734) | 0.729 | 0.542 | 0.439 | 0.802 | 1.322 |
主胰管直径 | 0.645(0.582~0.707) | 0.864 | 0.425 | 0.425 | 0.864 | |
腹膜胰颈前距离 | 0.686(0.607~0.765) | 0.966 | 0.342 | 0.419 | 0.953 | 38.7 |
ECV分数 | 0.778(0.709~0.847) | 0.847 | 0.717 | 0.595 | 0.905 | 0.325 |
Nomogram | 0.837(0.766~0.898) | 0.932 | 0.725 | 0.625 | 0.956 | 264 |
PD术后CR-POPF一直是研究的热点和难点,目前大多数关于术后胰瘘的预测模型如FRS评分等包括了术中及术后因素,如胰腺质地、术中失血量、术后病理等[29-30]。这些预测模型虽然有着较好的预测效能,但却无法在术前使用。术前早期识别胰瘘高危患者,可以制订更加详实的手术计划、更加谨慎地签署知情同意书、进行更加个体化的术后管理。目前少有利用术前临床和影像学指标构建列线图来预测CR-POPF,本研究列线图利用术前临床易得的客观指标进行预测,并发现其展示了良好的预测效能,在临床实际应用中简单方便。
腹膜胰颈前距离可反应胰颈与腹膜之间的脂肪厚度,该处脂肪增多会增加手术探查及胰肠吻合的难度,亦会影响术后吻合口的愈合,该指标在术前容易获得并且测量方式简单。既往研究[27]表明,在内脏型肥胖患者中,该指标明显增高,CR-POPF的概率更大。
本研究发现ALT和AST比值与术后CR-POPF关系密切,并且为其独立危险因素(OR=2.221,P=0.004)。既往一项大型队列研究[31]表明(共纳入8 097例患者),ALT/AST为非酒精性脂肪胰的独立危险因素。胰腺脂肪浸润会导致胰肠吻合口处机械阻力降低,过多的脂肪也会造成慢性炎症反应,影响组织的愈合速度[32-34]。目前关于术前肝功能相关指标与术后CR-POPF二者之间的关系存在一定争议,王振勇等[35]研究表明,术前高胆红素是LPD术后CR-POPF的独立危险因素,本研究并未发现术前总胆红素与术后CR-POPF之间存在统计学意义,有关二者之间的联系仍需大样本、多中心的研究来进一步证明。PD患者术前常常伴有黄疸及转氨酶的升高,目前关于ALT与AST和CR-POPF之间的研究较少,Sert等[36]研究表明术前高ALT、AST为术后胰瘘的危险因素,但该研究样本量较小(50例)。本研究中单因素分析并未发现ALT、AST与CR-POPF之间存在统计学差异,但将两指标联合起来(ALT/AST)却是CR-POPF的独立危险因素。既往并未有报道ALT/AST这一指标与CR-POPF的关系,本研究发现二者具有相关性,并将其纳入列线图中,未来需要多中心、大样本的研究来进一步探讨该指标与CR-POPF的关系。
主胰管直径作为目前公认的CR-POPF的危险因素,本研究结果与既往研究结果相同[37]。由于粗大的胰管直径会降低胰肠吻合的难度,胰管黏膜与空肠黏膜吻合更加确切且胰液通过吻合口时较通畅,因此术后CR-POPF的发生率较低[4,13,38]。CT为PD术前的常规检查,利用CT测量该指标简单易得,因此可以在术前测量患者的主胰管直径,然后利用模型对术后CR-POPF进行预测。
随着CT、MRI的普及,ECV分数的应用日益广泛。研究[39-41]表明ECV与恶性肿瘤、肝纤维化、心肌组织水平等存在关联。Sofue等[23]研究表明,利用多期CE-CT的ECV分数可以无创地估计胰腺纤维化的组织学分级。此外,ECV分数有助于预测PD术后胰瘘的发生及风险分层。在重度纤维化的胰腺中,ECV分数明显升高。由于重度纤维化的胰腺外分泌功能降低,胰腺质地较硬,发生CR-POPF的可能性较小。Zhu等[22]利用高分辨率多频磁共振弹性成像发现ECV分数为CR-POPF的预测因子,在一定程度上与胰腺硬度相关。既往的预测模型中,很少纳入这一指标。本研究发现ECV分数为术后CR-POPF的独立危险因素,并将其纳入至列线图中,发现其预测效能良好,且ECV分数的计算所需指标均为术前易得指标,可供外科医生参考。
本研究列线图使用的变量均为术前临床方便获得指标,并展示了良好的预测效能。相比于术后发生胰瘘时所采取补救性治疗,术前识别胰瘘高危患者可以制定更加详实的手术策略及术后个体化治疗,如术中放置胰管支架管、适合的胰肠吻合方式、积极的腹腔引流,术后早期应用生长抑素,积极测量腹腔引流液的淀粉酶、早期复查腹部CT、引流液细菌培养等,以防止高危患者出现胰瘘后的进一步发展,如腹腔感染、出血等。
本研究存在一定的局限性。首先这是一项单中心回顾性研究,样本量较小,缺少外部验证,这可能导致预测模型在准确度方面存在一定的偏倚。未来需要前瞻性、大样本、多中心的研究进一步提高该模型的预测能力和稳定性。此外需要说明的是本研究CR-POPF的发生率为33.0%,可能相比较其他中心较高,这可能与排除了一些胰腺重度萎缩的患者有关,因为这些患者往往不伴有胰瘘。
[1] |
RICHARDS JR, KNOPF NA, WANG L, et al. Blunt abdominal trauma in children: evaluation with emergency US[J]. Radiology, 2002, 222( 3): 749- 754. DOI: 10.1148/radiol.2223010838.
|
[2] |
HO VP, PATEL NJ, BOKHARI F, et al. Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma[J]. J Trauma Acute Care Surg, 2017, 82( 1): 185- 199. DOI: 10.1097/TA.0000000000001300.
|
[3] |
AHMED N, VERNICK JJ. Pancreatic injury[J]. South Med J, 2009, 102( 12): 1253- 1256. DOI: 10.1097/SMJ.0b013e3181c0dfca.
|
[4] |
ANTONSEN I, BERLE V, SØREIDE K. Blunt pancreatic injury in children[J]. Tidsskr Nor Laegeforen, 2017, 137( 17). DOI: 10.4045/tidsskr.16.0888.
|
[5] |
ROSENFELD EH, VOGEL A, RUSSELL RT, et al. Comparison of diagnostic imaging modalities for the evaluation of pancreatic duct injury in children: a multi-institutional analysis from the Pancreatic Trauma Study Group[J]. Pediatr Surg Int, 2018, 34( 9): 961- 966. DOI: 10.1007/s00383-018-4309-2.
|
[6] |
DI SERAFINO M, VITALE V, SEVERINO R, et al. Pediatric ultrasonography of the pancreas: normal and abnormal findings[J]. J Ultrasound, 2019, 22( 3): 261- 272. DOI: 10.1007/s40477-018-0348-8.
|
[7] |
SUTHERLAND I, LEDDER O, CRAMERI J, et al. Pancreatic trauma in children[J]. Pediatr Surg Int, 2010, 26( 12): 1201- 1206. DOI: 10.1007/s00383-010-2705-3.
|
[8] |
HERMAN R, GUIRE KE, BURD RS, et al. Utility of amylase and lipase as predictors of grade of injury or outcomes in pediatric patients with pancreatic trauma[J]. J Pediatr Surg, 2011, 46( 5): 923- 926. DOI: 10.1016/j.jpedsurg.2011.02.033.
|
[9] |
TAN Y, HAN LQ, YANG Q, et al. Impairment of endocrine function in acute pancreatitis[J/CD]. Chin J Clinicians(Electronic Edition), 2018, 12( 9): 535- 538. DOI: 10.3877/cma.j.issn.1674-0785.2018.09.011.
谭杨, 韩连强, 杨奇, 等. 急性胰腺炎时胰腺内分泌功能损伤的研究进展[J/CD]. 中华临床医师杂志(电子版), 2018, 12( 9): 535- 538. DOI: 10.3877/cma.j.issn.1674-0785.2018.09.011.
|
[10] |
RICHARDSON A, PARK WG. Acute pancreatitis and diabetes mellitus: a review[J]. Korean J Intern Med, 2021, 36( 1): 15- 24. DOI: 10.3904/kjim.2020.505.
|
[11] |
DONG Q, LI L, XIAO XM, et al. Pediatric hepatobiliary surgery[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2017.
董蒨, 李龙, 肖现民, 等. 小儿肝胆外科学[M]. 第二版. 北京: 人民卫生出版社, 2017.
|
[12] |
SRINIVASAN V. Glucose metabolism and stress hyperglycemia in critically Ill children[J]. Indian J Pediatr, 2023, 90( 3): 272- 279. DOI: 10.1007/s12098-022-04439-y.
|
[13] |
LOSSER MR, DAMOISEL C, PAYEN D. Bench-to-bedside review: Glucose and stress conditions in the intensive care unit[J]. Crit Care, 2010, 14( 4): 231. DOI: 10.1186/cc9100.
|
[14] |
DAS SL, SINGH PP, PHILLIPS AR, et al. Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis[J]. Gut, 2014, 63( 5): 818- 831. DOI: 10.1136/gutjnl-2013-305062.
|
[15] |
BHARMAL SH, PENDHARKAR SA, SINGH RG, et al. Relationship between circulating levels of pancreatic proteolytic enzymes and pancreatic hormones[J]. Pancreatology, 2017, 17( 6): 876- 883. DOI: 10.1016/j.pan.2017.09.007.
|
[16] |
CHO IR, HAN KD, LEE SH, et al. Association between glycemic status and the risk of acute pancreatitis: a nationwide population-based study[J]. Diabetol Metab Syndr, 2023, 15( 1): 104. DOI: 10.1186/s13098-023-01086-x.
|
[17] |
PENDHARKAR SA, ASRANI VM, XIAO AY, et al. Relationship between pancreatic hormones and glucose metabolism: A cross-sectional study in patients after acute pancreatitis[J]. Am J Physiol Gastrointest Liver Physiol, 2016, 311( 1): G50- G58. DOI: 10.1152/ajpgi.00074.2016.
|
[18] |
ANDERSEN DB, HOLST JJ. Peptides in the regulation of glucagon secretion[J]. Peptides, 2022, 148: 170683. DOI: 10.1016/j.peptides.2021.170683.
|
[19] |
BELLIN MD. Pancreatogenic diabetes in children with recurrent acute and chronic pancreatitis: risks, screening, and treatment(mini-review)[J]. Front Pediatr, 2022, 10: 884668. DOI: 10.3389/fped.2022.884668.
|
[20] |
FRANKE D, ANUPINDI SA, BARNEWOLT CE, et al. Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children[J]. Pediatr Radiol, 2021, 51( 12): 2229- 2252. DOI: 10.1007/s00247-021-05131-7.
|
[21] |
ZHANG D, CHEN YJ, WANG ZM, et al. Management of blunt pancreatic trauma in children: a report of 42 cases[J]. J Clin Ped Surg, 2018, 17( 7): 523- 527. DOI: 10.3969/j.issn.1671-6353.2018.07.011.
张丹, 陈亚军, 王增萌, 等. 小儿不同级别闭合性胰腺损伤的疗效分析[J]. 临床小儿外科杂志, 2018, 17( 7): 523- 527. DOI: 10.3969/j.issn.1671-6353.2018.07.011.
|
[22] |
PALTIEL HJ, BARTH RA, BRUNO C, et al. Contrast-enhanced ultrasound of blunt abdominal trauma in children[J]. Pediatr Radiol, 2021, 51( 12): 2253- 2269. DOI: 10.1007/s00247-020-04869-w.
|
[23] |
LAUGESEN NG, NOLSOE CP, ROSENBERG J. Clinical applications of contrast-enhanced ultrasound in the pediatric work-up of focal liver lesions and blunt abdominal trauma: a systematic review[J]. Ultrasound Int Open, 2017, 3( 1): E2- E7. DOI: 10.1055/s-0042-124502.
|
[24] |
GOLDBERG-MUROW M, STEINER Z, LAKOVSKY Y, et al. Blunt high-grade pancreatic injury in children: a 20-year experience in two pediatric surgical centers[J]. Isr Med Assoc J, 2021, 23( 3): 180- 185.
|
[25] |
DARGE K, BACK SJ, BULAS DI, et al. Pediatric contrast-enhanced ultrasound: shedding light on the pursuit of approval in the United States[J]. Pediatr Radiol, 2021, 51( 12): 2128- 2138. DOI: 10.1007/s00247-021-05102-y.
|
[26] |
MENICHINI G, SESSA B, TRINCI M, et al. Accuracy of contrast-enhanced ultrasound(CEUS) in the identification and characterization of traumatic solid organ lesions in children: a retrospective comparison with baseline US and CE-MDCT[J]. Radiol Med, 2015, 120( 11): 989- 1001. DOI: 10.1007/s11547-015-0535-z.
|
[27] |
SQUIRES JH, MCCARVILLE MB. Contrast-enhanced ultrasound in children: implementation and key diagnostic applications[J]. AJR Am J Roentgenol, 2021, 217( 5): 1217- 1231. DOI: 10.2214/AJR.21.25713.
|
[28] |
ESPOSITO F, DI SERAFINO M, SGAMBATI P, et al. Ultrasound contrast media in paediatric patients: is it an off-label use? Regulatory requirements and radiologist’s liability[J]. Radiol Med, 2012, 117( 1): 148- 159. DOI: 10.1007/s11547-011-0718-1.
|
[29] |
ZHANG Z, HONG Y, LIU N, et al. Diagnostic accuracy of contrast enhanced ultrasound in patients with blunt abdominal trauma presenting to the emergency department: a systematic review and meta-analysis[J]. Sci Rep, 2017, 7( 1): 4446. DOI: 10.1038/s41598-017-04779-2.
|
[30] |
LIN TK, TROENDLE DM, WALLIHAN DB, et al. Specialized imaging and procedures in pediatric pancreatology: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Clinical Report[J]. J Pediatr Gastroenterol Nutr, 2017, 64( 3): 472- 484. DOI: 10.1097/MPG.0000000000001371.
|
[31] |
MIELE V, PICCOLO CL, TRINCI M, et al. Diagnostic imaging of blunt abdominal trauma in pediatric patients[J]. Radiol Med, 2016, 121( 5): 409- 430. DOI: 10.1007/s11547-016-0637-2.
|
[32] |
LV F, TANG J, LUO Y, et al. Emergency contrast-enhanced ultrasonography for pancreatic injuries in blunt abdominal trauma[J]. Radiol Med, 2014, 119( 12): 920- 927. DOI: 10.1007/s11547-014-0410-3.
|
[33] |
NAKAOKA K, HASHIMOTO S, MIYAHARA R, et al. Current status of the diagnosis of chronic pancreatitis by ultrasonographic elastography[J]. Korean J Intern Med, 2022, 37( 1): 27- 36. DOI: 10.3904/kjim.2021.252.
|
[34] |
ZHU L, YANG JR, HE LL, et al. Advances on the application of transient elastography in the diagnosis of liver fibrosis[J/CD]. Chin J Liver Dis(Electronic Version), 2023, 15( 3): 16- 22. DOI: 10.3969/j.issn.1674-7380.2023.03.003.
朱璐, 杨君茹, 何玲玲, 等. 瞬时弹性成像在肝纤维化诊断中的应用研究进展[J/CD]. 中国肝脏病杂志(电子版), 2023, 15( 3): 16- 22. DOI: 10.3969/j.issn.1674-7380.2023.03.003.
|
[35] |
DONG M, ZHANG BY, XING BY. Application progress of ultrasound elastography in breast diseases[J]. China Med Herald, 2022, 19( 22): 42- 45, 61.
董梦, 张秉宜, 邢博缘. 超声弹性成像技术在乳腺疾病中的应用进展[J]. 中国医药导报, 2022, 19( 22): 42- 45, 61.
|
[36] |
YAMASHITA Y, YAMAZAKI H, SHIMOKAWA T, et al. Shear-wave versus strain elastography in endoscopic ultrasound for the diagnosis of chronic pancreatitis[J]. Pancreatology, 2023, 23( 1): 35- 41. DOI: 10.1016/j.pan.2022.11.009.
|
[37] |
WU J, LIU YF, KONG WW, et al. Advances in the diagnosis and treatment of pediatric acute pancreatitis[J]. J Clin Hepatol, 2017, 33( 6): 1196- 1200. DOI: 10.3969/j.issn.1001-5256.2017.06.039.
吴杰, 刘羽飞, 孔文文, 等. 儿童急性胰腺炎诊断与治疗的研究进展[J]. 临床肝胆病杂志, 2017, 33( 6): 1196- 1200. DOI: 10.3969/j.issn.1001-5256.2017.06.039.
|
[38] |
GIRARD E, ABBA J, ARVIEUX C, et al. Management of pancreatic trauma[J]. J Visc Surg, 2016, 153( 4): 259- 268. DOI: 10.1016/j.jviscsurg.2016.02.006.
|
[1] | Ru JIA, Pingping ZHANG, Yuan YUAN, Yiyang HU, Qin FENG. Differences and application value of plasma bile acids in tumors of the liver[J]. Journal of Clinical Hepatology, 2024, 40(10): 2042-2048. doi: 10.12449/JCH241018 |
[2] | Dazhi LI, Junjie HUANG, Shusen ZHENG, Aibin ZHANG. Role of thioredoxin reductase 1 in multidrug resistance caused by reactive oxygen species-related cell apoptosis in hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2022, 38(2): 372-380. doi: 10.3969/j.issn.1001-5256.2022.02.022 |
[3] | Guoxiang CHEN, Mo ZHOU, Sheng CHEN, Yuan WANG, Yuanlong ZHOU, Jihong YANG. Mechanism of action of non-coding RNA in sorafenib resistance in hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2021, 37(3): 699-703. doi: 10.3969/j.issn.1001-5256.2021.03.040 |
[4] | YANG Xu, SUN WenBing, GAO Jun. Diagnosis and treatment of hepatic vascular tumors[J]. Journal of Clinical Hepatology, 2020, 36(11): 2569-2573. doi: 10.3969/j.issn.1001-5256.2020.11.039 |
[5] | WANG WenHui, DUAN XuHua, LI Hao, LI FengYao, JU ShuGuang, WANG ManZhou, REN JianZhuang, HAN XinWei. Effect of arsenic trioxide-loaded CalliSpheres beads in the treatment of rabbits with VX2 liver tumor[J]. Journal of Clinical Hepatology, 2020, 36(12): 2730-2734. doi: 10.3969/j.issn.1001-5256.2020.12.018 |
[6] | ZHANG ZhongLin, YUAN YuFeng. Key operating points of laparoscopic hepatectomy for liver tumor in difficult locations[J]. Journal of Clinical Hepatology, 2020, 36(12): 2663-2666. doi: 10.3969/j.issn.1001-5256.2020.12.006 |
[7] | Kong Li, Zhang YuZhuo, Jin Meng, Wang ShanShan, Du JingHua, Zhang YuGuo, Wang RongQi, Ren WeiGuang, Nan YueMin. mRNA expression and significance of tumor necrosis factor-alpha-induced protein 8-like 2 and forkhead box P3 in peripheral blood mononuclear cells in patients with primary liver cancer[J]. Journal of Clinical Hepatology, 2019, 35(12): 2721-2724. doi: 10.3969/j.issn.1001-5256.2019.12.016 |
[8] | Li ShanShan, Zhang Ke, Cheng ShuJie, Yang JiHong, Gao Feng, Li JingHua. Current status and future perspectives of the application of medical 3D visualization technology in accurate surgery of liver tumors[J]. Journal of Clinical Hepatology, 2019, 35(5): 1114-1117. doi: 10.3969/j.issn.1001-5256.2019.05.042 |
[9] | Wang ZhiYu, Gu SanWei, Chen XiaoQian, Cai YanJun. Clonorchiasis misdiagnosed as hepatic tumor: a case report[J]. Journal of Clinical Hepatology, 2018, 34(3): 602-603. doi: 10.3969/j.issn.1001-5256.2018.03.033 |
[10] | Lu NingNing, Sun Bin, Cui XiongWei, Long Jiang, Gao WenFeng, Zheng JiaSheng. Diagnosis and treatment of subcapsular hemorrhage after liver tumor ablation[J]. Journal of Clinical Hepatology, 2017, 33(12): 2326-2330. doi: 10.3969/j.issn.1001-5256.2017.12.014 |
[11] | Lin Kun, Ci DanWangJiu, Chang ZhiHui, Liu ZhaoYu. Clinical value of circulating micro RNAs in hepatic,biliary and pancreatic carcinomas[J]. Journal of Clinical Hepatology, 2015, 31(5): 790-795. doi: 10.3969/j.issn.1001-5256.2015.05.040 |
[12] | Ji Bo, Liu YaHui. Research advances in role of myeloid- derived suppressor cells in tumorigenesis[J]. Journal of Clinical Hepatology, 2014, 30(9): 939-943. doi: 10.3969/j.issn.1001-5256.2014.09.026 |
[13] | Chen MinHua. Standardization of thermal ablation in treatment of liver tumor[J]. Journal of Clinical Hepatology, 2013, 29(8): 561-563. doi: 10.3969/j.issn.1001-5256.2013.08.001 |
[14] | Wang JiPing, Leng JiYan, Cui YaQiong, Zhang Li, Wang Yan. The diagnosis and clinical value of multi-slice spiral CT in children with common liver tumor[J]. Journal of Clinical Hepatology, 2011, 27(7): 718-721. |
[15] | Chen Hong, Wang Zhi, Wu Jian. Circulating tumor cells of hepatocellular carcinoma and their clinical implications[J]. Journal of Clinical Hepatology, 2011, 27(8): 796-800. |
[17] | Yang BiWei, Gan YuHong, Ye ShengLong, Zhang BoHeng, Ren ZhengGang, Xia JingLin, Wang YanHong, Ge NingLing, Chen Yi, Li LiXin, Le Fan, Zhang Lan. Necrosis range and safety of radiofrequency combined with systemic chemotherapy and radiofrequency alone.[J]. Journal of Clinical Hepatology, 2004, 20(6): 364-365. |
变量 | 数值 |
---|---|
性别[例(%)] | |
女 | 63(35.2) |
男 | 116(64.8) |
年龄(岁) | 62.0(56.0~69.0) |
糖尿病[例(%)] | |
否 | 141(78.8) |
是 | 38(21.2) |
高血压[例(%)] | |
否 | 125(69.8) |
是 | 54(30.2) |
BMI(kg/m2) | 23.38±3.23 |
手术方式[例(%)] | |
PD | 129(72.1) |
LPD | 50(27.9) |
术前减黄[例(%)] | |
否 | 120(67.0) |
是 | 59(33.0) |
主胰管直径[例(%)] | |
≤3 mm | 120(67.0) |
>3 mm | 59(33.0) |
CT判断血管侵犯[例(%)] | |
否 | 162(90.5) |
是 | 17(9.5) |
CR-POPF[例(%)] | |
否 | 120(67.0) |
是 | 59(33.0) |
术前血细胞比容 | 0.38(0.35~0.41) |
术前血红蛋白(g/L) | 129.00(118.00~138.00) |
术前前白蛋白(mg/L) | 170.17±55.70 |
术前白蛋白(g/L) | 37.10(34.20~39.20) |
术前总胆红素(μmol/L) | 101.30(18.50~210.10) |
ALT(U/L) | 126.19(41.81~237.50) |
AST(U/L) | 82.82(30.60~151.45) |
ALT/AST | 1.40(1.04~1.85) |
CA19-9(KU/L) | 77.12(15.83~335.60) |
胰腺平扫期CT值(Hu) | 41.10(35.05~46.13) |
胰腺动脉期CT值(Hu) | 84.80(69.50~96.33) |
胰腺静脉期CT值(Hu) | 95.95(81.33~109.95) |
胰腺平衡期CT值(Hu) | 81.05±14.73 |
脾脏平扫期CT值(Hu) | 52.65(48.83~55.30) |
肝脏平扫期CT值(Hu) | 56.20±6.61 |
主动脉平扫期CT值(Hu) | 43.30(38.35~47.50) |
主动脉平衡期CT值(Hu) | 115.70(105.55~126.35) |
胰/脾CT比值 | 0.77±0.15 |
胰/肝CT比值 | 0.72±0.15 |
肾后脂肪厚度(mm) | 8.80(4.30~15.75) |
脐周脂肪厚度(mm) | 16.55(12.40~22.71) |
腹膜胰颈前距离(mm) | 50.43±1.19 |
ECV分数 | 0.33(0.27~0.39) |
变量 | 非CR-POPF(n=120) | CR-POPF(n=59) | 统计值 | P值 |
---|---|---|---|---|
性别[例(%)] | χ2=3.680 | 0.055 | ||
女 | 48(40.0) | 15(25.4) | ||
男 | 72(60.0) | 44(74.6) | ||
年龄[例(%)] | χ2=0.574 | 0.449 | ||
≤60岁 | 56(46.7) | 24(40.7) | ||
>60岁 | 64(53.3) | 35(59.3) | ||
糖尿病[例(%)] | χ2=1.826 | 0.177 | ||
否 | 98(81.7) | 43(72.9) | ||
是 | 22(18.3) | 16(27.1) | ||
高血压[例(%)] | χ2=0.005 | 0.945 | ||
否 | 84(70.0) | 41(69.5) | ||
是 | 36(30.0) | 18(30.5) | ||
BMI[例(%)] | χ2=3.455 | 0.063 | ||
≤25 kg/m2 | 93(77.5) | 38(64.4) | ||
>25 kg/m2 | 27(22.5) | 21(35.6) | ||
手术方式[例(%)] | χ2=1.556 | 0.272 | ||
开腹 | 90(75.0) | 39(66.1) | ||
腹腔镜 | 30(25.0) | 20(33.9) | ||
术前减黄[例(%)] | χ2=0.276 | 0.599 | ||
否 | 82(68.3) | 38(64.4) | ||
是 | 38(31.7) | 21(35.6) | ||
CT判断血管侵犯[例(%)] | χ2=0.046 | 0.830 | ||
否 | 109(90.8) | 53(89.8) | ||
是 | 11(9.2) | 6(10.2) | ||
主胰管直径[例(%)] | χ2=14.992 | <0.001 | ||
≤3 mm | 69(57.5) | 51(86.4) | ||
>3 mm | 51(42.5) | 8(13.6) | ||
术前血细胞比容 | 0.37(0.35~0.41) | 0.39(0.34~0.42) | Z=-1.166 | 0.244 |
术前血红蛋白(g/L) | 126.00(118.00~134.00) | 132.00(116.00~142.00) | Z=-1.862 | 0.063 |
术前前白蛋白(mg/L) | 169.86±52.96 | 170.80±56.81 | t=-0.109 | 0.913 |
术前白蛋白(g/L) | 36.90(33.90~39.10) | 37.80(34.60~40.30) | Z=-1.047 | 0.295 |
术前总胆红素(μmol/L) | 99.50(16.82~209.93) | 112.50(34.50~221.40) | Z=-0.655 | 0.512 |
ALT(U/L) | 119.95(40.57~231.06) | 143.62(44.98~229.75) | Z=-0.331 | 0.740 |
AST(U/L) | 85.44(31.86~169.99) | 77.73(30.20~121.69) | Z=-0.902 | 0.367 |
ALT/AST | 1.27(1.00~1.68) | 1.53(1.21~2.02) | Z=-3.188 | 0.001 |
CA19-9(KU/L) | 94.82(10.39~487.13) | 53.90(25.47~257.90) | Z=-0.124 | 0.901 |
胰腺平扫期CT值(Hu) | 41.33(35.65~46.00) | 39.05(34.70~46.15) | Z=-0.813 | 0.416 |
胰腺动脉期CT值(Hu) | 84.17(68.71~95.56) | 88.00(76.25~92.00) | Z=-1.837 | 0.066 |
胰腺静脉期CT值(Hu) | 96.63(82.79~109.51) | 95.70(81.10~110.30) | Z=-0.175 | 0.861 |
胰腺平衡期CT值(Hu) | 85.90(75.13~92.95) | 71.50(67.70~79.40) | Z=-4.833 | <0.001 |
脾脏平扫期CT值(Hu) | 52.58(48.8~55.21) | 52.50(49.45~54.95) | Z=-0.075 | 0.94 |
肝脏平扫期CT值(Hu) | 56.01±6.76 | 56.59±6.33 | t=-0.546 | 0.586 |
主动脉平扫期CT值(Hu) | 42.56±7.06 | 42.15±6.48 | t=0.369 | 0.713 |
主动脉平衡期CT值(Hu) | 116.20(105.78~130.78) | 116.30(107.40~125.80) | Z=-0.074 | 0.941 |
胰/脾CT比值 | 0.80(0.67~0.89) | 0.76(0.66~0.87) | Z=-0.942 | 0.346 |
胰/肝CT比值 | 0.73±0.16 | 0.71±0.13 | t=0.978 | 0.329 |
肾后脂肪厚度(mm) | 8.24(3.80~14.51) | 11.60(6.30~16.50) | Z=-2.068 | 0.039 |
脐周脂肪厚度(mm) | 15.95(12.10~21.71) | 19.10(14.30~25.30) | Z=-2.189 | 0.029 |
腹膜胰颈前距离(mm) | 46.99±16.31 | 57.43±12.56 | t=-4.718 | <0.001 |
ECV分数 | 0.36(0.32~0.41) | 0.29(0.24~0.31) | Z=-6.045 | <0.001 |
变量 | β值 | OR(95%CI) | P值 |
---|---|---|---|
主胰管直径(≤3 mm vs >3 mm) | -1.117 | 0.276(0.105~0.725) | 0.022 |
ALT/AST | 0.798 | 2.221(1.281~3.851) | 0.004 |
胰腺平衡期CT值 | -0.008 | 0.992(0.956~1.030) | 0.691 |
肾后脂肪厚度 | -0.01 | 0.990(0.937~1.047) | 0.732 |
脐周脂肪厚度 | 0.002 | 1.002(0.956~1.050) | 0.937 |
腹膜胰颈前距离 | 0.034 | 1.034(1.004~1.066) | 0.027 |
ECV分数 | -9.126 | 0.001(0.000~0.067) | 0.005 |
变量 | AUC(95%CI) | 敏感度 | 特异度 | PPV | NPV | Cut-off |
---|---|---|---|---|---|---|
ALT/AST | 0.647(0.560~0.734) | 0.729 | 0.542 | 0.439 | 0.802 | 1.322 |
主胰管直径 | 0.645(0.582~0.707) | 0.864 | 0.425 | 0.425 | 0.864 | |
腹膜胰颈前距离 | 0.686(0.607~0.765) | 0.966 | 0.342 | 0.419 | 0.953 | 38.7 |
ECV分数 | 0.778(0.709~0.847) | 0.847 | 0.717 | 0.595 | 0.905 | 0.325 |
Nomogram | 0.837(0.766~0.898) | 0.932 | 0.725 | 0.625 | 0.956 | 264 |
变量 | 数值 |
---|---|
性别[例(%)] | |
女 | 63(35.2) |
男 | 116(64.8) |
年龄(岁) | 62.0(56.0~69.0) |
糖尿病[例(%)] | |
否 | 141(78.8) |
是 | 38(21.2) |
高血压[例(%)] | |
否 | 125(69.8) |
是 | 54(30.2) |
BMI(kg/m2) | 23.38±3.23 |
手术方式[例(%)] | |
PD | 129(72.1) |
LPD | 50(27.9) |
术前减黄[例(%)] | |
否 | 120(67.0) |
是 | 59(33.0) |
主胰管直径[例(%)] | |
≤3 mm | 120(67.0) |
>3 mm | 59(33.0) |
CT判断血管侵犯[例(%)] | |
否 | 162(90.5) |
是 | 17(9.5) |
CR-POPF[例(%)] | |
否 | 120(67.0) |
是 | 59(33.0) |
术前血细胞比容 | 0.38(0.35~0.41) |
术前血红蛋白(g/L) | 129.00(118.00~138.00) |
术前前白蛋白(mg/L) | 170.17±55.70 |
术前白蛋白(g/L) | 37.10(34.20~39.20) |
术前总胆红素(μmol/L) | 101.30(18.50~210.10) |
ALT(U/L) | 126.19(41.81~237.50) |
AST(U/L) | 82.82(30.60~151.45) |
ALT/AST | 1.40(1.04~1.85) |
CA19-9(KU/L) | 77.12(15.83~335.60) |
胰腺平扫期CT值(Hu) | 41.10(35.05~46.13) |
胰腺动脉期CT值(Hu) | 84.80(69.50~96.33) |
胰腺静脉期CT值(Hu) | 95.95(81.33~109.95) |
胰腺平衡期CT值(Hu) | 81.05±14.73 |
脾脏平扫期CT值(Hu) | 52.65(48.83~55.30) |
肝脏平扫期CT值(Hu) | 56.20±6.61 |
主动脉平扫期CT值(Hu) | 43.30(38.35~47.50) |
主动脉平衡期CT值(Hu) | 115.70(105.55~126.35) |
胰/脾CT比值 | 0.77±0.15 |
胰/肝CT比值 | 0.72±0.15 |
肾后脂肪厚度(mm) | 8.80(4.30~15.75) |
脐周脂肪厚度(mm) | 16.55(12.40~22.71) |
腹膜胰颈前距离(mm) | 50.43±1.19 |
ECV分数 | 0.33(0.27~0.39) |
变量 | 非CR-POPF(n=120) | CR-POPF(n=59) | 统计值 | P值 |
---|---|---|---|---|
性别[例(%)] | χ2=3.680 | 0.055 | ||
女 | 48(40.0) | 15(25.4) | ||
男 | 72(60.0) | 44(74.6) | ||
年龄[例(%)] | χ2=0.574 | 0.449 | ||
≤60岁 | 56(46.7) | 24(40.7) | ||
>60岁 | 64(53.3) | 35(59.3) | ||
糖尿病[例(%)] | χ2=1.826 | 0.177 | ||
否 | 98(81.7) | 43(72.9) | ||
是 | 22(18.3) | 16(27.1) | ||
高血压[例(%)] | χ2=0.005 | 0.945 | ||
否 | 84(70.0) | 41(69.5) | ||
是 | 36(30.0) | 18(30.5) | ||
BMI[例(%)] | χ2=3.455 | 0.063 | ||
≤25 kg/m2 | 93(77.5) | 38(64.4) | ||
>25 kg/m2 | 27(22.5) | 21(35.6) | ||
手术方式[例(%)] | χ2=1.556 | 0.272 | ||
开腹 | 90(75.0) | 39(66.1) | ||
腹腔镜 | 30(25.0) | 20(33.9) | ||
术前减黄[例(%)] | χ2=0.276 | 0.599 | ||
否 | 82(68.3) | 38(64.4) | ||
是 | 38(31.7) | 21(35.6) | ||
CT判断血管侵犯[例(%)] | χ2=0.046 | 0.830 | ||
否 | 109(90.8) | 53(89.8) | ||
是 | 11(9.2) | 6(10.2) | ||
主胰管直径[例(%)] | χ2=14.992 | <0.001 | ||
≤3 mm | 69(57.5) | 51(86.4) | ||
>3 mm | 51(42.5) | 8(13.6) | ||
术前血细胞比容 | 0.37(0.35~0.41) | 0.39(0.34~0.42) | Z=-1.166 | 0.244 |
术前血红蛋白(g/L) | 126.00(118.00~134.00) | 132.00(116.00~142.00) | Z=-1.862 | 0.063 |
术前前白蛋白(mg/L) | 169.86±52.96 | 170.80±56.81 | t=-0.109 | 0.913 |
术前白蛋白(g/L) | 36.90(33.90~39.10) | 37.80(34.60~40.30) | Z=-1.047 | 0.295 |
术前总胆红素(μmol/L) | 99.50(16.82~209.93) | 112.50(34.50~221.40) | Z=-0.655 | 0.512 |
ALT(U/L) | 119.95(40.57~231.06) | 143.62(44.98~229.75) | Z=-0.331 | 0.740 |
AST(U/L) | 85.44(31.86~169.99) | 77.73(30.20~121.69) | Z=-0.902 | 0.367 |
ALT/AST | 1.27(1.00~1.68) | 1.53(1.21~2.02) | Z=-3.188 | 0.001 |
CA19-9(KU/L) | 94.82(10.39~487.13) | 53.90(25.47~257.90) | Z=-0.124 | 0.901 |
胰腺平扫期CT值(Hu) | 41.33(35.65~46.00) | 39.05(34.70~46.15) | Z=-0.813 | 0.416 |
胰腺动脉期CT值(Hu) | 84.17(68.71~95.56) | 88.00(76.25~92.00) | Z=-1.837 | 0.066 |
胰腺静脉期CT值(Hu) | 96.63(82.79~109.51) | 95.70(81.10~110.30) | Z=-0.175 | 0.861 |
胰腺平衡期CT值(Hu) | 85.90(75.13~92.95) | 71.50(67.70~79.40) | Z=-4.833 | <0.001 |
脾脏平扫期CT值(Hu) | 52.58(48.8~55.21) | 52.50(49.45~54.95) | Z=-0.075 | 0.94 |
肝脏平扫期CT值(Hu) | 56.01±6.76 | 56.59±6.33 | t=-0.546 | 0.586 |
主动脉平扫期CT值(Hu) | 42.56±7.06 | 42.15±6.48 | t=0.369 | 0.713 |
主动脉平衡期CT值(Hu) | 116.20(105.78~130.78) | 116.30(107.40~125.80) | Z=-0.074 | 0.941 |
胰/脾CT比值 | 0.80(0.67~0.89) | 0.76(0.66~0.87) | Z=-0.942 | 0.346 |
胰/肝CT比值 | 0.73±0.16 | 0.71±0.13 | t=0.978 | 0.329 |
肾后脂肪厚度(mm) | 8.24(3.80~14.51) | 11.60(6.30~16.50) | Z=-2.068 | 0.039 |
脐周脂肪厚度(mm) | 15.95(12.10~21.71) | 19.10(14.30~25.30) | Z=-2.189 | 0.029 |
腹膜胰颈前距离(mm) | 46.99±16.31 | 57.43±12.56 | t=-4.718 | <0.001 |
ECV分数 | 0.36(0.32~0.41) | 0.29(0.24~0.31) | Z=-6.045 | <0.001 |
变量 | β值 | OR(95%CI) | P值 |
---|---|---|---|
主胰管直径(≤3 mm vs >3 mm) | -1.117 | 0.276(0.105~0.725) | 0.022 |
ALT/AST | 0.798 | 2.221(1.281~3.851) | 0.004 |
胰腺平衡期CT值 | -0.008 | 0.992(0.956~1.030) | 0.691 |
肾后脂肪厚度 | -0.01 | 0.990(0.937~1.047) | 0.732 |
脐周脂肪厚度 | 0.002 | 1.002(0.956~1.050) | 0.937 |
腹膜胰颈前距离 | 0.034 | 1.034(1.004~1.066) | 0.027 |
ECV分数 | -9.126 | 0.001(0.000~0.067) | 0.005 |
变量 | AUC(95%CI) | 敏感度 | 特异度 | PPV | NPV | Cut-off |
---|---|---|---|---|---|---|
ALT/AST | 0.647(0.560~0.734) | 0.729 | 0.542 | 0.439 | 0.802 | 1.322 |
主胰管直径 | 0.645(0.582~0.707) | 0.864 | 0.425 | 0.425 | 0.864 | |
腹膜胰颈前距离 | 0.686(0.607~0.765) | 0.966 | 0.342 | 0.419 | 0.953 | 38.7 |
ECV分数 | 0.778(0.709~0.847) | 0.847 | 0.717 | 0.595 | 0.905 | 0.325 |
Nomogram | 0.837(0.766~0.898) | 0.932 | 0.725 | 0.625 | 0.956 | 264 |