影响胰十二指肠切除术后并发症发生的相关因素分析

Risk Factors of Postoperative Complications of Pancreatoduodenectomy

背景与目的:胰十二指肠切除术是治疗胰腺及壶腹部癌的首选治疗方式,本研究旨在探讨影响胰腺及壶腹部癌行胰十二指肠切除术术后并发症的危险因素。方法:收集1993年1月至2006年11月在广州医学院第二附属医院和甘肃省肿瘤医院行胰十二指肠切除术且资料完整的胰腺及壶腹部癌患者94例。选择13个可能对胰十二指肠切除术疗效产生影响的非重复特征性临床因素进行单因素分析,通过Cox比例风险模型对胰十二指肠切除术后的并发症发生率和死亡率进行多因素分析。结果:单因素分析发现,血清胆红素水平、血清白蛋白、术前黄疸持续时间、术前有否减黄治疗、手术时间、术中出血量和肿瘤浸润深度7个为危险因素(P均<0.05);通过Cox模型进行多变量分析发现,与并发症发生率、死亡率有关的独立因素为术中出血量(P<0.01)、手术时间(P均<0.01)、血清胆红素水平(P均<0.01)和黄疸持续时间(P<0.01)。结论:影响胰十二指肠切除术后并发症发生率和死亡率的主要危险因素为术中出血量、手术时间、血清胆红素水平和黄疸持续时间。

BACKGROUND ＆ OBJECTIVE, Pancreatoduodenectomy is the main treatment for pancreatic carcinoma and periampullary carcinoma. This study was to explore risk factors of postoperative complications of pancreatoduodenectomy for pancreatic carcinoma and periampullary carcinoma. METHODS. Clinical data of 94 patients with pancreatic carcinoma or periampullary carcinoma, underwent pancreatoduodenectomy at the second affiliated hospital of Guangzhou Medical Collage and Gansu Provincial Tumor Hospital from Jan. 1993 to Nov. 2006, were analyzed. Thirteen clinicopathologic factors that could possibly influence postoperative mortality and morbidity were selected for univariate analysis and multivariate analysis using Cox proportional hazards model. RESULTS. Univariate analysis showed that major risk factors of postoperative mortality and morbidity of the patients were total serum bilirubin level, serum album level, duration of jaundice, decompression of jaundice, operating time, intraoperative bleeding, and depth of tumor invasion （P〈0.05）. Multivariate analysis showed that intra-operative bleeding, operating time, total serum bilirubin level, and duration of jaundice were independent risk factors （P〈 0.01）. CONCLUSION. Postoperative mortality and morbidity of pancreatoduodenectomy for periampullary carcinoma are closely related to intra-operative bleeding, operating time, serum bilirubin level and duration of jaundice.