预防性使用奥曲肽对腹腔镜胰十二指肠切除术后并发症的影响分析

熊笑笑; 王骥; 马红钦; 刘利; 杜羽升; 赵文星

doi:10.3969/j.issn.1000-8179.2021.09.517

预防性使用奥曲肽对腹腔镜胰十二指肠切除术后并发症的影响分析

Role of prophylactic octreotide in reducing the complication rate after laparoscopic pancreaticoduodenectomy

摘要

摘要:
目的探究腹腔镜胰十二指肠切除术（laparoscopic pancreatoduodenectomy，LPD）后预防性使用奥曲肽是否可以减低术后胰瘘（postoperative pancreatic fistula，POPF）及其他术后并发症的发生。
方法分析2018年9月至2020年5月徐州医科大学附属医院接受腹腔镜胰十二指肠切除术96例患者的围手术期资料，根据患者术后是否预防性使用奥曲肽分为奥曲肽组（47例）和对照组（49例）。比较两组患者术后胰瘘（生化瘘、B、C级）及其他并发症的发生率、术后首次通气时间、术后住院天数、术后营养等数据。
结果奥曲肽组生化瘘10例，B级瘘为6例，未发生C级瘘，对照组生化瘘9例，B级瘘有5例，C级瘘1例，两组胰瘘发生率分别为生化瘘：（21.3% vs. 18.4%）、B级瘘：（12.8% vs. 10.2%）、C级瘘（0 vs. 2.0%），两组之间比较差异均无统计学（P>0.05）；奥曲肽组术后首次通气时间较对照组短（3.9±1.4）d vs.（4.5±1.0）d，两组之间呈显著性差异（P=0.013）；术后第7天总蛋白、白蛋白、前白蛋白营养指标比较，奥曲肽组好于对照组，（65.71±4.03）g/L vs.（63.53±5.53）g/L；（41.42±3.41）g/L vs.（39.75±3.92）g/L；（0.16±0.05）g/L vs.（0.14±0.04）g/L，两组之间呈显著性差异（P=0.030、0.029、0.033）；奥曲肽组术后住院时间较对照组短（12.7±3.9）d vs.（14.7± 5.4）d，差异具有统计学意义（P=0.042）。
结论预防性使用奥曲肽不能降低术后胰瘘的发生率，但奥曲肽组患者较对照组患者首次排气时间缩短，可加速术后恢复，缩短术后住院时间。

Abstract:
Objective To evaluate whether the prophylactic use of octreotide after laparoscopic pancreaticoduodenectomy (LPD) can reduce the incidence of postoperative pancreatic fistula (POPF) formation and other complications.
Methods The perioperative data of 96 patients who underwent LPD in The Affiliated Hospital of Xuzhou Medical University from September 26, 2018, to May 12, 2020, were collected; patients were assigned into an octreotide group (47 cases) and a control group (49 cases). The incidence of POPF formation (biochemical fistula, fistula grade B or C) and other complications, as well as the postoperative duration of mechanical ventilation, length of hospital stay, and nutritional status were compared between the two groups.
Results In the octreotide group, there were ten cases of biochemical fistula, six cases of grade B fistula, and no cases of grade C fistula. In the control group, there were nine cases of biochemical fistula, five cases of grade B fistula, and one case of grade C fistula. The incidence of POPF formation in the two groups (octreotide vs. control) was as follows: biochemical fistula, 21.3% vs. 18.4%; grade B fistula, 12.8% vs. 10.2%; and grade C fistula, 0 vs. 2.0%. There were no significant differences between the two groups (P>0.05). On the postoperative day 7, the nutritional indices, namely the total protein, albumin and prealbumin levels, in the octreotide group were significantly better than those in control group total protein: (65.71±4.03) g/L vs. (63.53±5.53) g/L, P=0.030; albumin: (41.42±3.41) g/L vs. (39.75±3.92) g/L, P=0.029; prealbumin: (0.16±0.05) g/L vs. (0.14±0.04) g/L, P=0.033. The duration of mechanical ventilation in the octreotide group was significantly shorter than that in the control group (3.9±1.4) vs. (4.5±1.0) days; P=0.013. The postoperative length of hospital stay in the octreotide group was also significantly shorter than that in the control group (12.7±3.9) vs. (14.7±5.4) days; P=0.042.
Conclusions In the current study, prophylactic use of octreotide was not able to reduce the incidence of POPF formation. Nonetheless, patients in the octreotide group required mechanical ventilation for a shorter duration, recovered earlier, and had a shorter length of hospital stay postoperatively compared to the control group patients.

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