胰头十二指肠切除术后患者再手术的危险因素分析

Analysis of risk factors for reoperation after pancretoduodenectomy

目的：探讨胰头十二指肠切除术（Whipple术）后再手术的危险因素。方法回顾性分析2000年1月至2009年12月在中山大学附属第一医院行Whipple术的339例患者临床资料。所有患者（或家属）均签署知情同意书，符合医学伦理学规定。其中男206例，女133例；年龄1～86岁，中位年龄55岁。根据术后有否再行手术将患者分为再手术组（24例）和非再手术组（315例），分析患者再手术情况及影响再手术的危险因素。再手术与临床参数的关系分析采用χ2检验，再手术的危险因素分析采用Logistic回归分析。结果患者的再手术率为7.1%（24/339）。再手术的主要原因为腹腔出血8例，其中合并胰瘘5例；上消化道出血7例，其中合并胰瘘2例；胰瘘合并腹腔感染2例；胆瘘1例；切口裂开6例。再手术24例中9例与胰瘘有关，5例死亡患者中4例为胰瘘患者。再手术与术前糖尿病、术中出血量有关（χ2=5.588,4.565；P〈0.05）。术前糖尿病、术中出血量〉400 ml为Whipple术后再手术的独立危险因素（OR=5.80,2.74；P〈0.05）。结论 Whipple术后胰瘘、切口裂开是导致再手术的主要原因。术前糖尿病、术中出血量〉400 ml是Whipple术后再手术的独立危险因素。

Objective To investigate the risk factors for reoperation after pancreaticoduodenectomy （Whipple）. Methods Clinical data of 339 patients who underwent Whipple in the First Afifliated Hospital of Sun Yat-sen University from January 2000 to December 2009 were analyzed retrospectively. The informed consents of all patients or relatives were obtained and the ethical committee approval was received. There were 206 males and 133 females with age ranging from 1 to 86 years old and the median age of 55 years old. According to whether the patients received reoperation after operation, they were divided into reoperation group （n=24） and non-reoperation group （n=315）. The reoperation of patients and its risk factors were analyzed. The relations between reoperation and clinical parameters were analyzed using Chi-square test and the risk factors for reoperation were analyzed using Logistic regression analysis. Results The reoperation rate of patients was 7.1%（24/339）. The main causes of reoperation included abdominal bleeding （n=8, 5 cases were complicated with pancreatic fistula）, upper gastrointestinal bleeding （n=7, 2 cases were complicated with pancreatic ifstula）, pancreatic ifstula complicated with abdominal infection （n=2）, biliary leakage （n=1）＆amp;nbsp;and wound rupture （n=6）. In 24 patients receiving reoperation, 9 cases were related with pancreatic ifstula. Four out of 5 death cases were with pancreatic ifstula. The reoperation was related to preoperative diabetes, intraoperative blood loss （χ2=5.588, 4.565;P〈0.05）. Preoperative diabetes, intraoperative blood loss〉400 ml were independent risk factors for reoperation after Whipple （OR=5.80, 2.74; P〈0.05）. Conclusions The main causes of reoperation after Whipple are pancreatic ifstula and wound rupture. Preoperative diabetes, intraoperative blood loss〉400 ml are independent risk factors for reoperation after Whipple.