胰十二指肠切除术治疗远端胆管癌术后并发症的风险因素分析

Risk factors for complications after pancreaticoduodenectomy for distal cholangiocarcinoma

目的探讨远端胆管癌(distal cholangiocarcinoma,dCCa)行胰十二指肠切除术(pancreatoduodenectomy,PD)后早期并发症发生的风险因素。方法回顾性分析2004年1月至2021年12月哈尔滨医科大学附属第二医院普外科收治的407例行PD的dCCa病人,记录术后胰瘘、腹腔感染、出血、胆漏和胃排空延迟发生的临床资料,通过单因素和多因素统计学方法分析术后并发症发生的风险因素。结果术前高胆红素、胰管直径细、术中失血量多、手术时间长、胰腺质地软与术后胰瘘的发生显著相关,其中胰管直径<3 mm、术中失血量≥1000 mL、胰腺质地软是术后胰瘘发生的独立风险因素;年龄、糖尿病、术前高胆红素、术前低白蛋白、开腹手术、术中失血量多、手术时间长是术后腹腔感染发生的风险因素,其中年龄≥65岁、糖尿病、手术时间≥480 min是腹腔感染发生的独立风险因素;术后出血与高血压、糖尿病、术前高胆红素、术中失血量、手术时间紧密相关,其中术前总胆红素≥171μmol/L和术中失血量≥1000 mL是术后出血发生的独立风险因素;体质量指数(BMI)、糖尿病、术前低血红蛋白、术前低白蛋白、术中失血量多是术后胆漏发生的风险因素,其中术前血红蛋白<90 g/L是术后胆漏发生的独立风险因素;年龄、术前高胆红素、术前低白蛋白、术中失血量多、手术时间长与术后胃排空延迟发生显著相关,其中手术时间≥480 min是术后胃排空延迟发生的独立风险因素。结论dCCa行PD术后早期并发症以胰瘘、腹腔感染、出血、胆漏和胃排空延迟多见,年龄、BMI、高血压、糖尿病、术前胆红素、术前血红蛋白、术前白蛋白、胰管直径、胰腺质地、术中失血量和手术时间是术后并发症发生的风险因素,根据风险因素评估术后并发症发生的高危人群,采取相应的预防措施,可有效阻断术后并发症的发生。

Objective To explore the risk factors for early complications after pancreaticodu-odenectomy(PD)for distal cholangiocarcinoma(dCCa).Methods From January 2004 to December 2021,retrospective analysis of clinical data was performed for 407 dCCa patients undergoing PD at Department of General Surgery at Second Affiliated Hospital of Harbin Medical University.Postoperative occurrences of pancreatic fistula,abdominal infection,hemorrhage,biliary leakage and delayed gastric emptying were recorded.And the related risk factors for postoperative complications were examined by univariate and multivariate statistical methods.Results Preoperative hyperbilirubin,fine pancreatic duct diameter,massive intraoperative blood loss,long operative duration and soft pancreatic texture were significantly correlated with the occurrence of postoperative pancreatic fistula.Pancreatic duct diameter<3 mm,intraoperative blood loss≥1000 mL and soft pancreatic texture were the independent risk factors of postoperative pancreatic fistula.Age,diabetes mellitus(DM),preoperative hyperbilirubin,preoperative low albumin,open surgery,intraoperative blood loss and long operative duration were the risk factors for postoperative abdominal infection.And age≥65 years,DM and operative duration≥480 min were independent risk factors for the occurrence of abdominal infection.Postoperative hemorrhage was closely correlated with hypertension,DM,preoperative hyperbilirubin,intraoperative blood loss and operative duration.Among them,preoperative total bilirubin≥171μmol/L and intraoperative blood loss≥1000 mL were the independent risk factors for the occurrence of postoperative hemorrhage.Body mass index(BMI),diabetes mellitus,preoperative low hemoglobin,preoperative low albumin and intraoperative blood loss were the risk factors for postoperative biliary leakage while preoperative hemoglobin<90 g/L was an independent risk factor for postoperative biliary leakage.Age,preoperative hyperbilirubin,preoperative low albumin,intraoperative blood loss and long operative duration were significantly associated with delayed gastric emptying while operative duration≥480 min was an independent risk factor for delayed gastric emptying.Conclusion After dCCa for PD,early complications include pancreatic fistula,abdominal infection,hemorrhage,biliary leakage and delayed gastric emptying.Age,BMI,hypertension,DM,preoperative bilirubin,preoperative hemoglobin,preoperative albumin,pancreatic tube diameter,pancreatic texture,intraoperative blood loss and operation time are risk factors for the occurrence of postoperative complications.Predicating the odds of postoperative complications based upon risk factors and taking corresponding interventions can effectively avert the occurrence of postoperative complications.