摘要
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 biliary-enteric 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 re-sults(albumin,total bilirubin,direct bilirubin,white blood cell count,red blood cell count,hemoglobin levels,coagula-tion 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 anasto-motic stenosis postoperatively)were collected.Patients were classified according to whether biliary stents were placed in-traoperatively.Multivariate Logistic regression analysis was used to identify factors influencing the use of biliary stents dur-ing 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 selec-tion 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 postop-eratively(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 preopera-tive cholangitis,preoperative obstructive jaundice,bile duct diameter,and postoperative cholangitis.A predictive nomo-gram for biliary-enteric anastomotic stenosis after PD was successfully constructed,with good discriminatory ability.关键词
胰十二指肠切除术/胆道支撑管/胆管炎/胆肠吻合口狭窄/预测列线图Key words
pancreaticoduodenectomy/biliary support tube/cholangitis/biliary-enteric anastomotic stenosis/prediction nomogram分类
临床医学
