壶腹周围癌术后胃排空障碍的危险因素分析

Risk factors of delayed gastric emptying after pancreaticoduodenectomy for periampullary carcinoma

目的探讨壶腹周围癌根治术后胃排空障碍的危险因素。方法回顾性分析2010年10月至2013年9月复旦大学附属中山医院根治性切除的96例壶腹周围癌患者的临床资料，对围手术期可能与胃排空障碍有关的临床病理因素进行分析。单因素分析采用Pearson名。检验，多因素分析采用Logistic回归模型。结果96例壶腹周围癌患者中17例出现术后胃排空障碍，发生率为18％。单因素分析结果显示：患者的性别、吻合方式、失血量、输血量及术后腹腔感染是壶腹周围癌根治术后胃排空障碍发生的危险因素（x^2=4．512、6．412、6．245、6．695、6．816，均P〈0．05）。多因素分析结果显示：胰胃吻合和术后腹腔感染是壶腹周围癌根治术后胃排空障碍发生的独立危险因素，相对危险度分别为4．031和5．281。结论壶腹周围癌术中采用胰胃吻合容易发生术后胃排空障碍；术后腹腔感染是导致术后胃排空障碍的另一重要因素。

Objective To investigate the risk factors of delayed gastric emptying after pancreaticoduodenectomy （PD） for periampullary carcinoma. Methods The clinical data of 96 periampullary carcinoma patients who received PD with or without pylorus preservation at Zhongshan Hospital Fudan University from October 2010 to September 2013 were retrospectively analyzed. The risk factors associated with delayed gastric emptying were analyzed. The univariate and multivariate analysis were done using the chi-square test and Logistic regression model respectively. Results A total of 17 patients had postoperative delayed gastric emptying, with the incidence of 18%. The results of univariate showed that female sex, pancreatogastrostomy, increased intraoperative blood loss and transfusions and postoperative abdominal infection were risk factors of delayed gastric emptying （x^2 = 4. 512, 6. 412, 6. 245, 6. 695, 6. 816, all P 〈 0. 05 ）. The results of multivariate analysis revealed that only pancreatogastrostomy and postoperative abdominal infection were independent risk factors of delayed gastric emptying （ OR = 4.031 and 5. 281 ）. Conclusions Pancreatogastrostomy and postoperative abdominal infection indicate a higher incidence of delayed gastric emptying after pancreaticodudenectomy for periampullary carcinoma.