76例老年患者胰十二指肠切除术近期并发症的防治

Clinical analysis of 76 cases of pancreaticoduodenectomy in senile patient

目的探讨老年患者胰十二指肠切除术术后并发症发生的原因和防治措施。方法回顾分析我院1992年1月￣2002年12月76例65岁以上的老年患者胰十二指肠切除术术后并发症发生的原因,并与同期65岁以下的胰十二指肠切除术患者进行比较,分析老年患者并发症发生的特点。结果术前有并存疾病的51例(67.1%)。45例行保留幽门的胰十二指肠切除术,31例行非保留幽门的胰十二指肠切除术,占同期胰十二指肠切除术的26.8%(76/284)。术后近期并发症的发生率为38.1(%29/76),同期<65岁组并发症的发生率为21.6%(45/208),两组比较差异有极显著性意义(χ2=7.05,P<0.01)。病死率为4.0%(3/76);同期<65岁组病死率为0.96%(2/208),两组比较差异有显著性意义(χ2=4.86,P<0.05)。结论老年壶腹周围肿瘤的患者应做好充分的术前准备,积极处理并存疾病,选择适当合理的术式,加强术后的监测和管理,可减少术后并发症发生、降低病死率。

[Objective] To study the causes of postoperative complications and methods of prophylaxis and treatment of pancreaticoduodenectomy in senile patients. [Method] Reviewed retrograde 76 cases of pancreaticoduodenectomy in senile patients （〉65 year-old） from January 1992 to December 2000, analyzed the causes and characteristics of postoperative complications by compared them with the younger group （≤65 year-old）. [Results] Senile patients amounted to 26.8% （76/284） in pancreaticoduodenectomy , 76.1percent of patients （51/76） suffered other diseases. Pylorus-preserved pancreaticoduodenectomy was performed in 45 cases （59.21%）, and classic pancreaticoduodenectomy in the others. Incidence of postoperative complication, in early stage was 38.1%（29/76）, higher significandy than 21.6%（45/208） in the younger group （X^2=7.05, P 〈0.01）. Mortality in the two groups were 4.0%（3/76） and 0.96%（2/208） respectively, significant difference existed between the two groups （X^2=4.86, P 〈0.05）. [Conclusion] Full preoperative preparation is very important for senile patients with para-ampullar cancer, positive treatment of other diseases, proper operative method and good postoperative management are key points for reducing incidence of complications and mortality.