合理的围手术期处理降低高龄患者区域性胰腺切除术的危险性

Reasonable perioperative management reducing the risk of regional pancreatectomy in senile patients

目的结合APACHEⅡ评分,探讨通过合理的围手术期处理,改善急性生理评分能否降低高龄对区域性胰腺切除术(RP)术后并发症和手术死亡的影响。方法对2002年1月至2005年10月行RP的276例患者采用APACHEⅡ评分系统行入院时、术前的动态评分,比较≥70岁组(A组,69例)和<70岁组(B组,207例)的差异。比较两组患者术后并发症和手术死亡情况。结果入院时,A组与B组的APACHEⅡ评分总分及A、B、C三项分值差异均有统计学意义(P<0.01)。术前,A组与B组的总分及A项分较入院时显著下降(P<0.01),两组间总分差异有统计学意义(P<0.01),A项分差异无统计学意义(P>0.05)。术后A组与B组的并发症发生率及手术死亡率差异无统计学意义(P>0.05)。结论合理的围手术期治疗可明显改善高龄行RP患者的急性生理状况(A项分),从而显著降低RP术后并发症及死亡危险,提示高龄并不是RP的绝对禁忌证。

Objective To reduce the risk of regional pancreatectomy in senile patients by reasonable perioperative management and improvement of acute physiological score in combination with APACHEII score system.Methods The consecutive 276 eases （from Jan.2002 to Oct. 2005） subject to region panereatectomy were divided into group A （〉/70 years old, n = 69） and group B （〈70 years old, n = 207） and dynamic scores measured by APACHEII score system were compared at admission and before operation. All the patients were subjected to reasonable perioperative therapy and the postoperative complications and mortality were compared between two groups. Results At admission, there was significant difference in the total APACHE Ⅱ scores and A,B, C items scores between group A and group B （ P 〈 0.01）. Before operation, the total scores and A item scores were significnatly reduced as compared with those at admission （ P 〈 0.01 ）, and there was significant difference in the total scores between group A and group B （ P 〈 0.05）, but not in A item scores between two groups（ P 〉 0.05）. The postoperative incidence of complications and death had no significant difference between group A and group B （ P 〉 0.05）. Conclusion The reasonable pcrioperative treatment could obviously imporve the acute physiological status （A item scores） in senile patients undergoing regional pancreatectomy and reduce the postoperative complication and mortality,suggesting senility is not the absolute contraindication of regional panereatectomy.