502例胰十二指肠切除术后主要并发症的临床分析

Clinical analysis of major postoperative complications of pancreatoduodenectomy in 502 cases

目的总结胰十二指肠切除术（PD）的主要并发症的原因和防治措施。方法回顾性分析1986年1月至2007年12月南京医科大学第一附属医院施行的502例PD，其中保留幽门的胰十二指肠切除术（PPPD）87例，联合切除19例。结果术后近期并发症的发生率为31．5％（158／502），手术死亡率为3．2％（16／502），因并发症而再手术32例，再手术死亡率9．4％（3／32）。以1999年为界将PD手术病人分为两个阶段进行对照，结果显示：第一、二阶段的手术并发症分别为33．7％（56／166）、30．4％（102／336），死亡率分别为4．2％（7／166）、2．4％（8／336），无显著差异。结论消化道和腹腔出血、胰瘘、多器官功能衰竭、腹腔感染等是PD病人死亡的主要原因。适当的围手术期处理和熟练的外科操作技术是降低手术并发症和死亡率的重要因素。

Objective To investigate the causes of major postoperative complications of pancreatoduodenectomy （PD） and explore measures for prevention and treatment of the complications. Methods A retrospective study was carried out on the data of 502 cases of PD performed in our hospital from January 1986 to December 2007. They included 87 cases of pylorus-preserved pancreaticoduodenectomy（PPPD）and 19 cases of pancreatoduodenectomy combined with vascular resection or other organs. Results Of the 502 cases, 31.5% had postoperative complications and 3.2% died. Thirtytwo patients underwent reoperation and 9.4%o of them died. The operative morbidity and mortality was 33.7%（56/166）,4.2%（7/166） before 1999 and 30.4%（102/336）, 2.4%（8/336） afterwards. However, there was no significant difference. Conclusion The ：major causes of death after PD were gastrointestinal/intra-abdominal hemorrhage, pancreatic leakage, multiple organ failure and intra-abdominal cavity infection. Appropriate perioperative care and excellent operative technique are important to reduce postoperative morbidity and mortality after PD.