胰十二指肠切除术后发生腹部主要并发症的危险因素

RISK FACTORS OF MAJOR INTRAABDOMINAL COMPLICATIONS AFTER PANCREATODUODENECTOMY

目的 腹部主要并发症 (吻合口瘘、腹腔出血及感染 )是胰十二指肠切除术后导致患者死亡的主要原因。本研究的目的是探讨发生腹部主要并发症的危险因素。方法 回顾 1994年 12月～ 2 0 0 3年 12月间接受胰十二指肠切除术的连续12 3例患者的病历资料。分析变量包括临床资料、实验室数据、手术因素、病理诊断和并发症。结果 腹部主要并发症的发生率为 2 8.5 % (35 / 12 3)。单变量分析表明 :黄疸、手术失血量、胰肠吻合方式、术后白蛋白及血红蛋白水平为有意义的相关因素 ;经L ogistic回归多变量分析确定了 4个独立与腹部主要并发症相关的变量 :黄疸 (OR=4 .4 17)、术后血红蛋白水平 (OR=11.0 6 5 )、手术失血量 (OR=3.2 0 7)及胰肠吻合方式 (OR=4 .30 0 )。结论 黄疸、术后血红蛋白低于 90 g/ L、手术失血量≥ 10 0 0 m

Objective Major intraabdominal complications, including anastomotic leakage and intrabdominal hemorrhage and abscess, is the leading cause of patients' death after pancreatoduodenectomy (PD). The aim of this study is to evaluate the risk factors related to major intraabdominal complications. Methods From Dec.1994 to Dec.2003,there were 123 patients underewent PD.The clinical data from those patients were analzed for this study.Results The incidence of major intraabdominal complications was 28.5%(35/123). Univariate analysis showed that the factors including jaundice, amount of blood loss, manner of pancreatojejunostomy, postoperative serum albumin concentration and serum hemoglobin level, were significantly associated with major intraabdominal complications. Multivariate analysis by logistic regression was used to identified four variables as independent factors associated with the occurrence of major intraabdominal complications:jaundice(OR=4.417), postoperative serum hemoglobin (OR=11.065), amount of blood loss(OR=3.207) and manner of pancreatojejunostomy (P=0.021).Conclusion The main risk factors of major intraabdominal complications after PD are jaundice, postoperative serum hemoglobin lower than 90 g/L, amount of blood loss more than or equal to 1000ml and the manner of pancreatojejunostomy.