Whipple手术死亡原因分析

An analysis of causes for death after performance of Whipple procedure

目的分析 Whipple 手术死亡原因,探讨降低手术病死率的方法和手段。方法回顾1980年初至1999年底20年间425例 Whipple 手术,对其中28例手术死亡病例的术前高危因素、术中情况、术后处理等因素进行分析探讨,提出防治严重并发症发生的方法。结果 425例手术中共死亡28例,手术病死率6.6%。死亡的28例中,男性16例,女性12例;年龄30～81岁;良性病变4例,恶性病变24例;术前24例患者合并有高危因素,其中合并二种以上高危因素的20例(71%);专业手术组手术病死率4.8%(16/331),非专业手术组手术病死率12.8%(12/94);手术时间4.5～17.0h,平均(7.8±2.6)h;术中出血量800～12000 ml(2 330±2 220)ml;术后严重并发症中,手术并发症包括消化道瘘、消化道出血、腹腔出血、腹腔严重感染等;非手术并发症包括心、肺、肝、肾等重要脏器功能衰竭以及严重代谢障碍等。19例患者因手术并发症而直接导致死亡,其中消化道瘘9例、腹腔出血4例、消化道出血3例、腹腔严重感染3例;9例患者由于非手术并发症死亡。结论 Whipple 手术死亡率受多方面因素影响;手术的专业化、规范化,术前重要脏器功能的合理评估,减少手术并发症的发生,提高严重并发症的处理水平,对降低手术病死率至关重要。

Objective To analyze causes for death after performance of Whipple procedure and explore methods and measures to decrease the mortality of Whipple procedure.Methods The clinical data of 425 cases underwent Whipple procedure in our department from 1980 to 1999 were reviewed. Of these 425 cases,28 died.Preoperative high risk factors,perioperative conditions and postoperative management in the 28 cases were analyzed so as to decrease the mortality in patients undergoing Whip- ple procedure.Results The operative mortality was 6.6%.Among the 28 patients died after receiv- ing Whipple procedure,16 were male and 12 female and their age ranged from 30 to 81.Twenty-four patients suffered from neoplasm while the other 4 from benign diseases.Preoperative high risks were found in 24 patients and 20 (71%) of them had two or more preoperative high risk factors.The mor- tality was 4.8% (16/331) and 12.8% (12/94) in professional operation group and non-professional group,respectively.The operational duration was 4.5～17 hours (7.8±2.6 hours) and the blood loss 800～1200 ml (2 330±2220 ml).The operative complications included tract fistula,bleeding,and severe infections etc.while the non-operative complications were important organic and metabolic fail- ures.A total of 19 cases died of operative complications (tract fistula in 9,abdominal bleeding in 4, tract bleeding in 3 and severe infections in 3) and 9 of non-operative complications.Conclusions The mortality after performance of Whipple procedure was influenced by many factors.Specialization and standardization of Whipple procedure,reasonable preoperative evaluation of functions of important or- gans,decreasing the morbidity and promoting the level of treating severe complications are very impor- tant for decreasing the mortality.