背景:关于胰腺手术后乳糜漏(CL)的现有研究主要集中在胰十二指肠切除术上,而缺乏对全胰腺切除术(TP)的研究。本研究旨在探讨CL的潜在危险因素,并建立胰腺肿瘤患者接受TP的预测模型。
方法:这项回顾性研究纳入了2015年1月至2023年12月在北京协和医院接受TP的90例连续患者。根据纳入标准,79例患者最终纳入以下分析。进行LASSO回归和多变量逻辑回归分析以确定与CL相关的危险因素并构建预测列线图。然后,ROC分析,校正曲线,决策曲线分析(DCA),并进行临床影响曲线(CIC)评估其区分度,准确度,和功效。由于样本量小,我们采用引导重采样方法,重复500次进行验证。最后,我们绘制并分析了CL患者术后引流量的趋势。
结果:我们发现静脉切除术(OR=4.352,95CI1.404-14.04,P=0.011)是TP后CL的独立危险因素。手术时间延长(OR=1.473,95CI1.015-2.237,P=0.052)也与CL发生率增加有关。我们将这两个因素包括在我们的预测模型中。自举后曲线下面积(AUC)为0.752(95CI0.622-0.874)。校正曲线,DCA和CIC在我们的列线图中显示出很高的准确性和临床益处。在CL患者中,静脉切除组和B级CL组的平均引流量明显较高。
结论:静脉切除术是TP术后乳糜漏的独立危险因素。在TP期间接受血管切除术的患者应警惕术后CL的发生。然后,我们构建了由静脉切除和手术时间组成的列线图,以预测接受TP的患者发生CL的几率。
BACKGROUND: Existing research on
chyle leak (CL) after pancreatic surgery is mostly focused on pancreaticoduodenectomy and lacks investigation on total pancreatectomy (TP). This study aimed to explore potential risk factors of CL and develop a predictive model for patients with pancreatic tumor undergoing TP.
METHODS: This retrospective study enrolled 90 consecutive patients undergoing TP from January 2015 to December 2023 at Peking Union Medical College Hospital. According to the inclusion criteria, 79 patients were finally included in the following analysis. The LASSO regression and multivariate logistic regression analysis were performed to identify risk factors associated with CL and construct a predictive nomogram. Then, the ROC analysis, calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were performed to assess its discrimination, accuracy, and efficacy. Due to the small sample size, we adopted the bootstrap resampling method with 500 repetitions for validation. Lastly, we plotted and analyzed the trend of postoperative drainage volume in CL patients.
RESULTS: We revealed that venous resection (OR = 4.352, 95%CI 1.404-14.04, P = 0.011) was an independent risk factor for CL after TP. Prolonged operation time (OR = 1.473, 95%CI 1.015-2.237, P = 0.052) was also associated with an increased incidence of CL. We included these two factors in our prediction model. The area under the curve (AUC) was 0.752 (95%CI 0.622-0.874) after bootstrap. The calibration curve, DCA and CIC showed great accuracy and clinical benefit of our nomogram. In patients with CL, the mean drainage volume was significantly higher in venous resection group and grade B CL group.
CONCLUSIONS: Venous resection was an independent risk factor for
chyle leak after TP. Patients undergoing vascular resection during TP should be alert for the occurrence of CL after surgery. We then constructed a nomogram consisted of venous resection and operation time to predict the odds of CL in patients undergoing TP.