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目的探讨胰腺癌术后肝转移的影响因素。方法回顾性分析2004年3月至2014年3月期间笔者所在医院136例胰腺癌手术患者的临床资料。采用卡方检验进行胰腺癌手术后肝转移影响因素的单因素分析,采用多因素Logistic回归分析进行独立危险因素分析。结果单因素分析结果显示:年龄、体质量指数(BMI)、是否合并脂肪肝、发病至确诊时间、是否有脉管癌栓、浸润深度、组织学分级及术后是否化疗是胰腺癌术后肝转移的影响因素(P<0.05);多因素Logistic回归分析结果显示:BMI(OR=2.824,95%CI=1.293~3.784,P=0.002)、是否合并脂肪肝(OR=2.709,95%CI=1.126~3.263,P=0.003)、发病至确诊时间(OR=1.673,95%CI=1.097~2.354,P=0.005)、是否有脉管癌栓(OR=3.263,95%CI 1.514~5.652,P=0.001)及组织学分级(OR=4.239,95%CI=2.943~6.907,P=0.000)是胰腺癌手术后肝转移的独立影响因素。结论肥胖、发病至确诊时间长、有脉管癌栓及中低分化癌是胰腺癌术后肝转移的危险因素,而术前合并脂肪肝是胰腺癌患者术后肝转移的保护性因素。
Objective To investigate the influencing factors of postoperative liver metastasis of pancreatic cancer. Methods The clinical data of 136 patients with pancreatic cancer who underwent surgery in our hospital from March 2004 to March 2014 were analyzed retrospectively. Univariate analysis of the factors influencing liver metastasis after pancreatic cancer operation was conducted by chi square test. Independent risk factors were analyzed by multivariate Logistic regression analysis. Results The results of univariate analysis showed that age, body mass index (BMI), fatty liver, onset to definite diagnosis, whether there was vascular thrombosis, depth of invasion, histological grading and postoperative chemotherapy were postoperative liver cancer Multivariate logistic regression analysis showed that BMI (OR = 2.824, 95% CI = 1.293 ~ 3.784, P = 0.002), with or without fatty liver (OR = 2.709, 95% CI = (OR = 3.263, 95% CI 1.514-5.652, P = 0.003), the time from onset to diagnosis (OR = 1.673,95% CI = 1.097-2.354, P = 0.005) = 0.001) and histological grade (OR = 4.239,95% CI = 2.943 ~ 6.907, P = 0.000) were independent factors of liver metastasis after pancreatic cancer surgery. Conclusions Obese, the onset time to definite diagnosis, vascular thrombosis and moderately differentiated carcinoma are risk factors for postoperative liver metastases in patients with pancreatic cancer. Preoperative combined fatty liver disease is a protective factor for postoperative liver metastases in patients with pancreatic cancer.