胰十二指肠切除术后早期并发症危险因素分析

Analysis of risk factors of early postoperative complications after pancreaticoduodenectomy

目的总结胰十二指肠切除术(pancreaticoduodenectomy,PD)后早期并发症发生的危险因素。方法回顾1999年12月至2002年9月共200例胰十二指肠切除术的临床资料,分析早期并发症的发生情况及相关影响因素。结果术后并发症发生率为21%(42/200)。Logistic回归多变量分析确定了6个与早期并发症相关的变量胆肠吻合口未留置T型管引流(OR=10.015),术前最高胆红素水平大于等于171.1μmol/L(OR=7.756),术前合并糖尿病(OR=4.086)、采用端端胰肠吻合(OR=2.616)、术中输血量大于等于1000ml(OR=2.410)、年龄大于等于65岁(OR=2.162)。结论胰十二指肠切除术的手术风险目前仍然较高,胆肠吻合口留置T型管引流、端侧胰管空肠黏膜对黏膜吻合有助于降低并发症发生率,另外术者的操作熟练程度也影响术后并发症的发生。

Objective To investigate the risk factors of early postoperative complications in patients undergoing pancreaticoduodenectomy. Methods Clinical data of 200 patients undergoing pancreaticoduodenectomy in our hospital from December 1999 to September 2002 were collected and analyzed retrospectively. Nine clinical factors were recruited for the study in relation to surgical complications. Results The overall early postoperative complication rate was 21% （42/200）. Logistic regression analysis revealed that no T tube drainage（ OR = 10. 015 ） , preoperative total serum bilirubin level over 171.1 μmol/L （OR = 7. 756） , preoperative diabetes （ OR = 4. 086）, end-to-end pancreaticojejunostomy （ OR = 2. 616） , intraoperative blood transfusion over 1000 ml （ OR = 2. 410） , over 65 years old （ OR = 2. 162） were important factors for early complications. Conclusions T tube drainage, end-to-side mucosa-to-mucosa pancreaticojejunostomy and good surgical expertise can decrease early morbidity rate.