胰十二指肠切除术后并发症分析

Analysis of postoperative complications of pancreaticoduodenectomy

目的探讨胰十二指肠切除术(PD)后并发症发生原因及防治方法。方法回顾性分析近5年来154例行PD术患者的临床资料,其中采取胰肠套埋单层吻合105例,双层吻合49例。结果术后总并发症发生率为22.7%,两种吻合方式的术后并发症发生率(单层吻合18.1%,双层吻合32.7%),胰瘘发生率(单层吻合4.8%,双层吻合16.4%);术后平均住院时间[单层吻合(18.45±7.11)d,双层吻合(22.75±9.73)d]均有统计学差异(P<0.05)。多变量分析表明:男性、胰腺质地软、非单层胰肠吻合方式是3个与胰瘘发生相关的独立因素。结论合理的胰肠吻合方式及恰当的围手术期处理可有效减少胰瘘等术后并发症的发生率。

Objective To analyze the causes, prevention, and treatment of postoperative complications of pancreaticoduodenectomy （ PD ） . Methods A retrospective review of 154 consecutive patients who underwent PD with pancreaticojejunostomy in recent 5 years was carried out. In 105 cases, a single-layer invaginated pancreaticojejunostomy was used, and in 49 cases a double-layer invaginated pancreaticojejunostomy was used. Results The total complication rate after PD was 22.7 % . The surgery-related complication rate was 18. 1% （ 19 of 105 ） in single-layer anastomosis group, while it was 32.7 % （ 16 of 49,P = 0. 045） in the double-layer anastomosis group. The pancreatic fistula rate in the single-layer group was 4.8 % （ 5 of 105 ） and in the double-layer group was 16.4 % （ 8 of 49, P=0.016 ） . The mean length of hospital stay after PD was longer in the double-layer group [ （22.75 ± 9.73 ） d] as compared to the single-layer group [ （ 18.45 ± 7. 11 ） d ] （P = 0. 002 ） . Uni-and multivariate analysis showed 3 independent risk factors for pancreatic fistula formation： （1）male gender; （2） soft pancreatic gland; （3）not using a single-layer invaginated pancreaticojejunostomy. Conclusions The appropriate type of pancreaticojejunostomy and perioperative treatment can effectively decrease postoperative complications after PD.