胰十二指肠切除术严重并发症和病死率的多因素分析

Postoperative mortality and major complications after pancreaticoduodenectomy

目的探讨胰十二指肠切除术的术后严重并发症及其危险因素。方法回顾性分析1987年1月至2006年8月郑州大学第五附属医院138例行胰十二指肠切除术病人的手术死亡和术后严重并发症的情况,并通过单因素分析和多因素分析评价其危险因素。结果住院期间病人病死率为13.0%(18/138),与手术相关的严重并发症发生率为41.3%(57/138)。Logistic回归分析显示,发生并发症危险因素依次是术前总胆红素升高、低蛋白血症、高血压、年龄和术中出血量多。结论低蛋白血症和术前总胆红素升高是胰十二指肠切除术术后并发症最主要的危险因素,手术者掌握好手术适应证、积极纠正或削弱危险因素,能有效降低术后并发症的发生。

Objective To investigate the postoperative mortality and major complications after pancreaticoduodenectomy and its relationship with clinical risk factors. Methods The postoperative mortality and major complication incidence of 138 patients underwent pancreaticoduodenectomy between January 1987 and August 2006 in the Fifth Affdiated Hospital of Zhengzhou University. Univariate and multivariate analysis were used to analyze clinical risk factors. Results Postoperative severe complications were observed in 57 patients （41.3 % ）, and 18 patieras（ 13.0% ） died of complications. Logistic regression analysis revealed that total serum bilirubin level, hypoalbuminemia, hypertension, age and haemorrhage volume were the independently significant factors for postoperative major complications. Hypoalbuminemia , total serum bilirubin level, age and haemorrhage volume were the independently significant factors for operative mortality. Conclusion Hypoalbuminemia and total sown bilirubin level are the most important risk factors for outcome after panereatizoduodentectomy. It＇ s importara for surgeons to predominate opportunity and management of patients correctly for reducing postoperative complications.