胰十二指肠切除术中输血与未输血者356例比较分析

The impact of blood transfusion on postoperative short-term results of pan y.. a cornparative study on 356 patients

目的探讨输血与未输血行胰十二指肠切除术后并发症等有无差异。方法回顾性分析2005年1月至2011年12月行胰十二指肠切除术的356例资料，其中输血组242例，未输血组114例。结果输血组与未输血组的胰瘘发生率、肺感染发生率、平均手术时间、术中失血量、术后平均住院时间分别为17．8％、16．5％、6．4h、920ml、29．1d与8．8％、6．1％、5．4h、150ml、25．9d，两组差异有统计学意义（P〈0．05），而在胆瘘、出血、胃排空延迟、手术死亡率方面差异无统计学意义。结论（1）未输血组具有显著降低的胰瘘发生率、肺感染发生率、平均手术时间、术中失血量及术后平均住院时间。（2）引进先进的手术设备、精准操作、成立胰腺诊治中心或专业组，有利于减少术中失血量，降低术后相关并发症的发生。

Objective To study the impact of blood transfusion on postoperative complications of pancreaticoduodenectomy. Methods The medical data of 356 patients who underwent pancreaticoduodenectomy from January 2005 to December 2011 were retrospectively analyzed. 242 patients in the transfusion group received blood transfusion while the remaining patients in the non-transfusion group received no blood transfusion. Results The rates of pancreatic fistula and pulmonary infection, mean operative time, intraoperative blood loss, and hospital stay were 17.8%, 16.5%, 6.4 h, 920.0 ml and 29.1 d in the transfusion group compared with 8.8%, 6.1%, 5.4 h, 150.0 ml and 25.9 d in the non-transfusion group, respectively （P〈0.05）. However, there were no significant differences between the two groups in the rates of biliary fistula, gastrointestinal and intraabdominal bleeding, delayed gastric emptying and death. Conclusions Patients undergoing pancreaticoduodenectomy in the non-transfusion group had significantly lower rates of pancreatic fistula and pulmonary infection, shorter operative time and hospital stay, and less intraoperative blood loss. This study suggested that a reduction in intraoperative blood loss by advanced instruments and techniques, with oper- ations carried out by experienced pancreatic surgeons in specialized pancreatic center, could result in a significantly lower postoperative complication rate.