胰十二指肠切除术后腹内并发症和手术死亡的影响因素分析

Risk Factors of Intraabdominal Complications and Operative Death after Pancreatoduodenectomy

目的探讨胰十二指肠切除术(PD)后胰瘘等腹内并发症发生和手术死亡的相关危险因素,为临床有效减少其并发症发生和手术死亡提供理论依据。方法回顾性分析2003年6月至2011年11月期间上海交通大学医学院附属第三人民医院施行标准PD术的78例患者的临床资料,分析手术并发症、胰瘘及手术死亡的影响因素。结果术后发生并发症29例,其中胰瘘13例;手术死亡6例。单因素分析结果显示,影响胰瘘和术后并发症发生的因素有胰腺质地、胰管直径、术前胆道引流、胰管内置支撑管及应用生长抑素(P<0.05);未发现与手术死亡相关的因素。多因素分析结果显示,胰管内未置支撑管(OR=1.867,P=0.000)、胰腺质地软(OR=1.356,P=0.046)和胰管直径小于3 mm(OR=2.874,P=0.015)者的胰瘘发生率更高;胰管内未置支撑管(OR=1.672,P=0.030)、胰腺质地软(OR=1.946,P=0.042)和胰管直径小于3 mm(OR=1.782,P=0.002)者的手术并发症发生率更高;未发现与手术死亡相关的独立危险因素。结论术中胰管内是否置支撑引流管、胰腺质地和胰管直径是PD术后胰瘘和手术并发症发生的影响因素,行PD术应认真考虑这些因素并采取必要措施。

Objective To explore the risk factors of intraabdominal complications （IACs）, pancreatic fistula （PF）, and operative death after pancreatoduodenectomy （PD）, and to provide a theoretical basis in reducing the rates of them. Methods Clinical data of 78 patients who underwent standard PD surgery in The Third People＇s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jun. 2003 to Nov. 2011 were collected to analyze the influence factors of IACs, PF, and operative death. Results There were 29 cases suffered IACs （13 cases of PF included）, and 6 case died during 1 month after operation. Univariate analysis results showed that IACs and PF occurred more often in pati-ents with soft friable pancreas, diameter of main pancreatic duct less than 3 mm, preoperative biliary drainage, no pancr- eatic duct stenting, and without employment of somatostatin （P 〈 0. 05）, no influence factor was found to be related to operative death. Multivariate analysis results showed that patients with no pancreatic duct stenting （OR=1. 867, P=0. 000）, soft texture of remnant stump （OR=1. 356, P=0. 046）, and diameter of main pancreatic duct less than 3 mm （OR=2. 874, P=0. 015） suffered more IACs; PF was more frequent in patient with no pancreatic duct stenting （OR=1. 672, P=0. 030）, soft texture of remnant stump （OR=I. 946, P=0. 042）, and diameter of main pancreatic duct less than 3 mm （OR=1. 782, P=0. 002） ; no independent factor was found to have relationship with operative death. Conclusions Soft texture of remnant stump, diameter of main pancreatic duct less than 3 mm, and no pancreatic duct stenting are independent risk factors that should be considered in indications for PD surgery.