老年胰十二指肠切除术36例临床分析

An analysis of 36 cases of pancreaticoduodenectomy in elderly patients

目的探讨老年人胰十二指肠切除术指征,提高手术切除率及减少术后并发症的发生。方法回顾性总结2004～2010年间我院收治的36例≥65岁老年胰十二指肠切除术病例的临床资料,采用闭锁式胰腺套入吻合Child术式进行手术,使用术前"减黄"等措施减少手术并发症。结果 36例行胰十二指肠切除术患者中全部为恶性。胰瘘发生率为2.7%,36例患者中35例痊愈,死亡1例(死于肝衰竭)。结论可靠的诊断及合适的探查和适应证的严格把控能提高手术切除率。对老年人而言,完善的围手术期准备和精湛的手术技巧对提高胰十二指肠切除手术安全性、降低并发症尤为重要。

Objective To investigate the indications of the aged for pancreaticoduedonectomy so as to increase the proportion of resection and reduce the postoperative complications.Methods Clinical data of 36 elderly cases of pancreaticoduodenectomy performed from 2004 to 2010 were retrospectively analyzed.Modified Child method was used in the surgery.Measures such as jaundice reduction before operation were used to reduce the postoperative complications.Results All the cases were malignant in 36 cases of duodenopacreatectomy,and the total incidence of complication was 1.1%.The incidence of pancreatic fistula was 2.7%,35 cases acquired recovery and only 1case died（dying of hepatic failure）.Conclusions Potential diagnosis and appropriate exploration and indications extended can improve resective rate.For the aged,appropriate perioperative care and excellent operative technique are the key to improve the security and to reduce complications in pancreatoduodenectomy for elderly patients.