高龄病人胰十二指肠切除术围手术期处理

Perioperative management of pancreaticoduodenectomy in elderly patients

目的：分析70岁以上高龄病人胰十二指肠切除术（pancreaticoduodenectomy,PD）的临床资料并探讨其围手术期处理方法。方法回顾性分析老年人行 PD 的临床资料,将64例60岁以上 PD 手术病例分成高龄组（≥70岁,n=33）和低龄组（〈70岁,n =31）两组,比较两组术前合并症、术后并发症发生率及死亡率。结果高龄组与低龄组比较,高龄组术前合并症（主要是合并心肺疾病及低蛋白血症）的发生率明显高于低龄组（69.7%比38.7%,P =0.023）,两组比较差异有统计学意义（P〈0.05）；两组术后并发症发生率比较（54.5%比54.8%,P =1.000）和死亡率比较（12.1%比12.9%,P =1.000）,差异无统计学意义（P〉0.05）。结论术前矫治并存疾病并评估手术风险,术中精细操作,术后积极防治并发症,高龄病人行 PD 是安全可行的。

Objective To analyze the clinical data of elderly patients undergoing pancreaticoduo-denectomy （PD）and explore their treatment principles of perioperative period.Methods The clinical data were retrospectively analyzed for 64 patients aged over 60 years undergoing PD from August 2004 to August 2014.They were divided into elder （≥ 70 ys,n = 33 ）and non-elder （〈 70 ys,n = 31 ） groups according to age.The incidence rates of comorbidities,postoperative morbidity and mortality were compared.Results The incidence rates of such comorbidities as vasculopulmonary disease and hypoproteinemia were higher in elder group than those in non-elder group （69.7% vs 38.7%,P =0.023）.And there were significant inter-group differences （P〈 0.05 ）.No significant inter-group difference existed inpostoperative morbidity（54.5% vs 54.8%,P =1 .000）or mortality rate（12.1 % vs 12.9%,P =1 .000）（P〉0.05）.Conclusions Thus PD is both feasible and safe for elders if perioperative management is optimized,including preoperative correction of comorbidities,intraoperative skill-ful manipulations and postoperative supports and morbidity management.