扩大胰十二指肠切除术后并发症及其危险因素分析

Analysis of postoperative complications and risk factors following extended pancreaticoduodenectomy

目的探讨扩大胰十二指肠切除术(PD)对术后并发症的影响。方法回顾性分析2004年11月至2014年11月接受PD术的患者临床资料,根据手术方式不同将患者分成常规组和扩大组,对比两组间术后并发症发生情况,并分析并发症发生相关的危险因素。结果 358例手术患者分为常规组(321例)和扩大组(37例);术后总并发症发生率41.1%(147/358),术后死亡率5.0%(15/358)。扩大组较常规组的腹腔内并发症率(P=0.02)和胃排空功能障碍发生率(P=0.01)差异具有统计学意义。多变量Logistic回归分析显示腹腔内并发症的独立危险因素包括年龄≥65岁(P<0.01)、手术时间≥360 min(P=0.03)、胰管直径<3 mm(P<0.01)、胰腺质软(P<0.01)、扩大PD术(P=0.02)和套入式吻合(P=0.01);胃排空障碍的独立危险因素包括扩大切除(P=0.03)、手术时间≥360 min(P<0.01)、胰腺质软(P=0.02)和胰管直径<3 mm(P<0.01)。结论扩大PD术是术后腹腔内并发症的独立危险因素,但并未增加术后的死亡率。

Objective The present study aimed at investigating the comphcations following ex- tended pancreaticoduodenectomy and analyzing risk factors. Methods Clinical data of patients undergoing pancreaticoduodenectomy between November 2004 and November 2014 were collected, and were di- vided into Standard Group and Extended Group retrospectively. The postoperative complications and risk factors were analyzed by uni-variate and muhi-variate logistic analysis. Results Three hundred and fifty-eight patients were subjected to pancreaticoduodenectomy, 321 cases in Standard Group and 37 cases in Extended Group. The total morbidity was 41.1% and mortality was 5.0%. The differences of intra-ab- dominal complications （P = 0.02） and delayed gastric emptying （P = 0.01） were significant between the groups. Multi-variate logistic analysis revealed that age over 65 （P 〈 0.01）, operation time more than 360 min （P = 0.03）, pancreatic duct diameter less than 3 mm （P 〈 0.01）, soft texture of remnant pancreas （P 〈 0.01）, extended pancreaticoduodenectomy （P = 0.02） and invagination pancreaticojejunostomy （P = 0.01） were independent risk factors for intra-abdominal complications. And independent risk factors for delayed gastric emptying included extended pancreaticoduodenectomy （P = 0.03）, operation time more than 360 rain （P 〈 0.01）, soft texture of remnant pancreas （P = 0.02） and pancreatic duct diameter less than 3 mm （P 〈 0.01）. Conclusion Extended pancreaticoduodenectomy is the independent risk factor for intra-abdominal complications, while it does not increase the mortality.