老年患者胰十二指肠切除术后并发症及危险因素分析

Risk factors for pancreaticoduodenectomy in elderly patients

目的探讨老年患者（≥70岁）胰十二指肠切除术后并发症及危险因素。方法北京大学人民医院肝胆外科2005年1月至2016年12月行胰十二指肠切除术的患者358例，98例70岁及以上患者分为老年组，260例70岁以下患者分为非老年组。结果两组术前冠心病病史差异有统计学意义（P=0．008），术前白蛋白、ALT、碱性磷酸酶和肌酐差异均有统计学意义（均P〈0．05）。围手术期死亡率老年组比非老年组高（P=0．038），老年组术后系统并发症发生率较高（P=0．001）．其中术前总胆红素≥171 μmol／L和术中出血≥1000ml为独立危险因素。结论老年患者胰十二指肠切除术后围手术期死亡率较高，术后出现系统并发症的风险较大。

Objective To investigate the complication and risk factors in elderly patients undergoing pancreaticeduodenectomy （PD）. Methods From Jan 2005 to Dec 2016, 358 consecutive patients undergoing PD were divided into ≥70 years group （98 cases） and 〈 70 years group （260 patients）. Perioperative complications were compared and risk factors explored between the two groups. Results There were differences in coronary heart disease between the two groups in the preoperative medical comorbidities （ P = 0.008）, and that of albumin, alanine aminotransferase, alkaline phosphatase and creatinine （ all P〈0.05 ）. Perioperative mortality was higher in the elderly group than in the younger group （P =0.038）, probably related to higher systemic complications （P =0.001 ）. The independent risk factors influencing the postoperative medical complications were preoperative total bilirubin ≥ 171 μmol/L and intraoperative blood loss ≥ 1 000 ml. Conclusions Patients over 70 years old have a comparatively higher perioperative mortality rate after pancreaticoduodenectomy, which were probably derived from a higher postoperative vital organ dysfunction.