胰十二指肠切除术后主要并发症分析:附442例报告

Major postoperative complications of pancreaticoduodenal resection in 442 cases

目的:探讨胰十二指肠切除术(PD)后主要并发症发生情况与防治措施。方法:回顾性分析1994年8月—2010年12月442例PD术后并发症发生情况。按不同年代和不同胰肠吻合方式分组:1998年12月以前采用单纯胰-肠套入吻合(32例)为A组;此后的胰管空肠黏膜端侧吻合(305例)为B组;套入加捆绑式吻合(105例)为C组。分析各组手术直接相关和间接相关并发症的发生情况及病死率。结果:全组总并发症发生率为29.9%,总病死率为2.3%。3组间比较,B,C组各项指标均明显优于A组(均P<0.01),但B,C组间差异均无统计学意义(均P>0.05)。A,B,C组手术直接相关并发症分别为43.8%,6.6%,6.7%(其中胰瘘发生率分别为28.1%,3.6%,2.9%);间接相关并发症分别为59.4%,17.0%,19.0%;病死率分别为21.9%,0.7%,1.0%。结论:胰瘘的发生与采用何种胰肠吻合方式有关;熟练的手术技巧、仔细严密的吻合以及加强术前术后防范措施是降低PD术后并发症和病死率的重要因素。

Objective： To investigate the incidence of major postoperative complications after pancreatoduodenectomy（PD） and their prevention and control measures. Methods： The incidence of postoperative complications in 442 cases undergoing PD from August 1994 to December 2010 in our hospital was retrospectively studied.The cases were grouped according to different historical periods and different types of pancreatic-enteric anastomosis performed.Thirty-two cases undergoing pancreatic-enteric anastomosis by the invagination method before December 1998 were designated as group A,305 cases undergoing end-to-side duct-to-mucosa pancreatojejunostomy after that time were assigned as group B,and 105 cases with binding invagination anastomosis were group C.The direct or indirect operation-related postoperative complications and mortality of each group were analyzed. Results： The total incidence of complications and mortality of the whole group was 29.9% and 2.3%,respectively.Comparison among the three groups showed that all the studied postoperative parameters of groups B and C were better than those of group A（all P0.01）,but the differences between group B and C had no statistical significance（all P0.05）.The incidence of direct operation related complications of group A,B and C was 43.8%,6.6% and 6.7%（in which the incidence of pancreatic fistula was 28.1%,3.6% and 2.9%）,while the incidence of indirect operation related complications was 59.4%,17.0% and 19.0% and the mortality rate was 21.9%,0.7% and 1.0%,respectively. Conclusion： The prevalence of postoperative pancreatic fistula is related to the pancreaticojejunal anastomosis procedure.Expert surgical skill,meticulous technique of anastomosis and enhanced pre-and postoperative control measures are important factors for reducing complications and mortality after PD.