胰十二指肠切除术后早期并发症的影响因素分析

Risk factor analysis of early complications after pancreaticoduodenectomy

目的分析胰十二指肠切除术后早期并发症的风险因素。方法回顾性分析1999年1月—2009年10月中山大学附属第一医院收治的280例行胰十二指肠切除术患者的病例资料,其中男性175例,女性105例;平均年龄57岁,年龄范围为19~81岁。观察患者的围手术期情况和术后并发症情况。采用logistic回归分析法分析与术后早期并发症相关的风险因素。结果280例患者中,81.1%术前伴有梗阻性黄疸,中位手术时间为5.5h,术中失血量为(558.0±35.0)ml,16例实施多脏器联合切除。术后总的并发症发生率为31.1%。常见的术后并发症是腹腔感染/脓肿(10.4%)、出血(7.1%)和胰瘘(2.1%)。胰肠吻合方式主要采用套入式端端吻合(87.1%)和捆绑式胰肠吻合(7.9%)。logistic回归分析显示,年龄、有合并症、黄疸、术前减黄、胰腺质地、胰管放置内支架、预防性应用生长抑素、联合脏器切除和胰肠吻合方式均不是术后主要并发症的预测因素。结论胰十二指肠切除术后早期腹腔并发症发生率较高,围手术期常见风险因素与术后早期严重并发症的发生无明显相关性。

Objective To analyse of risk factors for early complications after pancreaticoduodenectomy. Methods Retrospective analysis of 280 cases of pancreaticoduodenectomy in the First Affiliated Hospital, Sun Yat-sen University from January 1999 to October 2009, including 175 males and 105 females;the average age was 57 years, the range is 19 to 81 years old. Observe the perioperative condition and postoperative complications of the patient. Logistic regression analysis was used to analyze risk factors associated with early postoperative complications. Results Among the 280 patients, 81.1% had preoperative jaundice with obstructive jaundice, the median operation time was 5.5 h. the intraoperative blood loss was (558.0±35.0) ml, 16 patients underwent multiple organ resection. The total postoperative complications was 31.1%. Common postoperative complications were abdominal infection/abscess (10.4%), hemorrhage (7.1%), and pancreatic fistula (2.1%). The pancreaticoenterostomy was mainly performed with a nested end-to-end anastomosis (87.1%) and a bundled pancreaticojejunostomy (7.9%). Logistic regression analysis showed that age, comorbidity, jaundice, preoperative yellowing, pancreatic texture, pancreatic duct placement, prophylactic application of somatostatin, combined organ resection and pancreaticojejunostomy were not predictor of major postoperative complications. Conclusions The incidence of early abdominal complication after pancreaticoduodenectomy is high. There is no significant correlation between the common risk factors in perioperative period and the occurrence of serious complications in the early postoperative period.