长期抗凝治疗患者行胰十二指肠切除术围手术期的安全性探讨

Perioperative safety of pancreaticoduodenectomy in patients with long-term anticoagulation therapy

目的探讨长期抗凝治疗患者行胰十二指肠切除术围手术期的安全性。方法回顾性分析2013年1月至2019年12月于北部战区总医院行胰十二指肠切除术的201例患者的临床资料,依据患者术前是否长期应用抗凝药物分为抗凝组(n=44)与对照组(n=157)。比较两组临床资料、相关化验指标、手术时间、术中出血量、术中输血量、术后并发症、住院时间、围手术期病死率等情况。结果两组年龄、性别、体重指数、凝血指标,手术前后总胆红素(TBIL)、丙氨酸转氨酶(ALT)、白蛋白(ALB)、血红蛋白(Hb)水平,手术时间、术中出血量及术后病理结果比较差异无统计学意义;两组美国麻醉医师协会分级分布比较差异有统计学意义(P<0.05);抗凝组术中输血量多于对照组,术中输血率高于对照组,住院时间长于对照组,差异有统计学意义(P<0.05)。两组胰瘘、胆瘘、腹腔感染、术后出血、胃排空障碍、围手术期死亡比较差异无统计学意义;抗凝组心血管并发症发生率为27.27%,高于对照组的10.83%,差异有统计学意义(P<0.05)。胰瘘与腹腔感染及术后出血呈正相关(r>0,P<0.05)。结论需要长期抗凝治疗的患者行胰十二指肠切除术是安全可行的,不会增加严重并发症发生率,但需要谨慎选择患者,并进行充分的术前评估。

Objective To investigate the perioperative safety of pancreaticoduodenectomy in patients with long-term anticoagulation therapy.Methods The clinical data of 201 patients who underwent pancreaticoduodenectomy in the General Hospital of Northern Theater Command from January 2013 to December 2019 were retrospectively analyzed,depending on whether the patients had been on long-term treatment with anticoagulant drugs before surgery,they were divided into the anticoagulation group(n=44)and the control group(n=157).The general information,related laboratory indicators,operative time,intraoperative blood loss,intraoperative blood transfusion,postoperative complications,hospital stay,perioperative mortality and other conditions were compared between the two groups.Results There were no statistically significant differences in age,gender,body mass index,coagulation indexes,the levels of total bilirubin(TBIL),alanine transaminase(ALT),albumin(ALB),operation time,intraoperative bleeding volume and postoperative pathology between the two groups before and after treatment;there was significant difference in American Society of Anesthesiologist(ASA)grading distribution between the two groups(P<0.05);the intraoperative blood transfusion volume in the anticoagulant group was higher than that in the control group,intraoperative blood transfusion rate was more than that in the control group,and the hospital stay was longer than that in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the comparison of pancreatic fistula,biliary fistula,abdominal infection,postoperative bleeding,gastric emptying obstruction and perioperative death between the two groups.The incidence of cardiovascular complications in the anticoagulant group was 27.27%,which was higher than 10.83%in the control group,and the difference was statistically significant(P<0.05).Pancreatic fistula was positively correlated with abdominal infection and postoperative hemorrhage(r>0,P<0.05).Conclusion Pancreaticoduodenectomy is safe and feasible in patients requiring long-term anticoagulant therapy and does not increase the incidence of serious complications,but patients should be carefully selected and fully evaluated before surgery.