胰十二指肠切除术后出血的危险因素分析

Analysis of risk factors for postoperative bleeding after pancreaticoduodenectomy

目的探讨胰十二指肠切除术后出血(消化道及腹腔出血)发生的危险因素。方法回顾性分析2004年12月—2008年1月305例行PD术患者的临床资料。结果术后出血发生率为9.18%(28例)。单变量分析表明:高血压病,术前胆红素水平,骨骼化清扫,内引流,手术失血量,术中输血量,术后血红蛋白水平,腹腔感染为有意义的相关因素;Logistic回归多变量分析确定4个与出血相关的独立变量,即:高血压病(OR=3.252),术前胆红素水平(OR=9.278),手术失血量(OR=2.714),腹腔感染(OR=4.796)。出血的预测方程:P=1/{1+exp[-(-4.8785+1.2892gxy+0.0082dhs+0.0004sxl+1.5721fqgr)]}。结论胰十二指肠切除术后出血的危险因素为高血压病,术前胆红素水平≥171μmol/L,手术失血量≥700 mL,腹腔感染。因此,恰当的围手术期处理和术者的熟练程度能有效减少PD术后出血发生率。

Objective To discuss the risk factors of postoperative bleeding after pancreaticoduodenectomy（PD）.Methods The clinical data of 305 patients receiving PD in our hospital from December 2004 to January 2008 were analyzed retrospectively.Results The incidence of postoperative bleeding was 9.18%.Univariate analysis showed that hypertension,preoperative blood serum bilirubin level,skeletization procedure,internal drainage,operative blood loss,intraoperative blood transfusion,post-operative hemoglobin levels and intra-abdominal infection were significantly associated with postoperative bleeding after PD.Multivariate analysis,using logistic regression,identified 4 variables as independent factors associated with the occurrence of bleeding,i.e.,hypertension,preoperative blood serum bilirubin level,operative blood loss,and intra-abdominal infection.The predictive equation was P =1/{1＋exp[-（-4.8785＋1.2892gxy＋0.0082dhs＋0.0004sxl＋1.5721fqgr）]}.Conclusions The independent risk factors for postoperative bleeding after PD are hypertension,preoperative blood serum bilirubin level more than or equal to 171 μmol/L,operative blood loss more than or equal to 700 mL,and intra-abdominal infection.Thus,appropriate perioperative management and degree of surgical skill of the operator can effectively decrease postoperative bleeding after PD.