老年病人胰十二指肠切除术可行性评价

Possibility evaluation of pancreaticoduodenectomy in elderly patients

目的探讨对老年病人实施胰十二指肠切除术的可行性,总结降低术后并发症发生率和病死率的经验。方法回顾性分析2002年5月至2007年5月复旦大学附属华东医院普外科行164例胰十二指肠切除术的临床资料,分析老年和非老年病人术前身体状况的评估指标、术后并发症和死亡危险因素。结果老年与非老年病人术前ASA评分及心功能分级差异有统计学意义。老年病人术后院内病死率高于非老年病人,死亡病例多发生在术后30d以后,两组术后并发症发生率的差异无统计学意义。术前低蛋白血症、术中失血>1000mL是术后并发症发生的危险因素。术后院内死亡的危险因素为年龄>70岁、术前低蛋白血症、术前合并冠心病和心功能分级>2。结论老年病人并不是胰十二指肠切除术的绝对禁忌证,术前改善营养状况,加强术后监护及治疗是降低并发症发生率和术后病死率的有效手段。

Objective To assess the possibility of pancreaticoduodenectomy in elderly patients, and try to find the way to reduce the morbidity and mortality after the procedure. Methods The clinical data of 164 cases of pancreaticoduodenectomy performed between May 2002 and May 2007 at Huadong Hospital of Fudan University were analyzed retrospectively. Some index involving preoperative health status, mortality and morbidity after pancreaticoduodenectomy were analyzed. Results There were significant differences on preoperative ASA grade, grades of heart function between elderly patients and younger patients. There was more frequent incident of mortality in elderly patients in hospital during more than 30 days after operation. No significant differences were noted in the incidence of complication between two groups. Both preoperative low serum albumin level and lost blood more than 1000 mL in operation were significant predictive factors for postoperative complications in univariate analysis of risk factors. The risk factors associated with death of patient in hospital were years old more than 70, preoperative low serum albumin level, comorbidity of coronary heart disease and the grade of heart function more than 2. Conclusion Age factor is not the contraindication for pancreaticoduodenectomy. The effective ways to decrease postoperative complication morbidity and mortality are to improve the nutritional status in elderly patients before operation and to strengthen the treatment of postoperative complications in ICU.