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目的 分析胰十二指肠切除术（PD）中胆道支撑管应用指征和术后胆肠吻合口狭窄的影响因素，构建PD术后胆肠吻合口狭窄的预测模型。方法 行PD治疗的患者323例，收集患者的临床资料，包括性别、年龄、合并症、肿瘤类别等常规指标，白蛋白、总胆红素、直接胆红素、白细胞计数、红细胞计数、血红蛋白、凝血功能指标等实验室检查指标，手术方式、手术时间、术中出血量、胆肠吻合缝线类型、胆管直径、是否应用胆道支撑管、术后发生胆肠吻合口狭窄等手术相关指标。按照术中是否放置胆道支撑管对患者进行分类，使用多因素Logistic回归分析法，采用向前法筛选PD术中放置胆道支撑管的影响因素。按照PD术后是否发生胆肠吻合口狭窄对患者进行分类，使用多因素Logistic回归分析法，采用向后法筛选PD术后发生胆肠吻合口狭窄的影响因素。使用R语言软件构建风险预测列线图，绘制列线图的ROC曲线评价列线图的区分度，绘制PR曲线评估列线图在不平衡场景下的识别能力。结果 胆管直径狭窄及缝线材质可吸收是PD术中放置胆道支撑管的独立影响因素（P均<0.05）；术前胆管炎、术前梗阻性黄疸、胆管直径、术后胆管炎是PD术后发生胆肠吻合口狭窄的独立影响因素（P均<0.05），构建了PD术后发生胆肠吻合口狭窄的预测列线图。列线图ROC曲线的AUC为0.878(95%CI:0.821～0.936)，列线图PR曲线的AUC为0.643。结论 PD术中放置胆道支撑管的应用指征为胆管直径狭窄和缝线材质可吸收。PD术后发生胆肠吻合口狭窄的独立影响因素为术前胆管炎、术前梗阻性黄疸、胆管直径、术后胆管炎，成功构建了PD术后发生胆肠吻合口狭窄的预测列线图，且列线图的区分度较好。
Abstract：Objective To analyze the indications for the use of biliary stents in pancreaticoduodenectomy(PD) and the influencing factors of postoperative biliary-enteric anastomotic stenosis, and to construct a predictive model for biliaryenteric anastomotic stenosis after PD. Methods A total of 323 patients who underwent PD were included in the study. Clinical data, including gender, age, comorbidities, tumor type, and other routine indicators, as well as laboratory test results(albumin, total bilirubin, direct bilirubin, white blood cell count, red blood cell count, hemoglobin levels, coagulation function indicators, etc.), and surgical factors(surgical method, operation time, intraoperative blood loss, type of biliary anastomosis suture, bile duct diameter, whether biliary stents were used, and occurrence of biliary-enteric anastomotic stenosis postoperatively) were collected. Patients were classified according to whether biliary stents were placed intraoperatively. Multivariate Logistic regression analysis was used to identify factors influencing the use of biliary stents during PD, with forward selection for the influencing factors. Patients were also classified according to whether biliary-enteric anastomotic stenosis occurred postoperatively, and multivariate Logistic regression analysis was used with backward selection to identify factors influencing the occurrence of biliary-enteric anastomotic stenosis. A risk prediction nomogram was constructed using R language software. The ROC curve of the nomogram was plotted to assess its discriminatory ability, and the PR curve was plotted to evaluate its recognition ability in imbalanced scenarios. Results Bile duct diameter stenosis and absorbable suture material were identified as independent factors influencing the use of biliary stents during PD(both P<0. 05). Preoperative cholangitis, preoperative obstructive jaundice, bile duct diameter, and postoperative cholangitis were identified as independent factors influencing the occurrence of biliary-enteric anastomotic stenosis postoperatively(all P<0. 05). A predictive nomogram for biliary-enteric anastomotic stenosis after PD was constructed. The AUC of the ROC curve for the nomogram was 0. 878(95% CI: 0. 821-0. 936), and the AUC of the PR curve was 0. 643. Conclusions The indications for the use of biliary stents during PD are bile duct diameter stenosis and absorbable suture material. The independent factors influencing the occurrence of biliary-enteric anastomotic stenosis after PD are preoperative cholangitis, preoperative obstructive jaundice, bile duct diameter, and postoperative cholangitis. A predictive nomogram for biliary-enteric anastomotic stenosis after PD was successfully constructed, with good discriminatory ability.
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基本信息:
DOI：
中图分类号:R657.5;R656.64
引用信息:
[1]董彪,马彦斌,侯孟森,等.胰十二指肠切除术中胆道支撑管应用指征分析及术后胆肠吻合口狭窄预测模型构建[J].山东医药,2025,65(10):1-7.
基金信息: