手术台次对胰十二指肠切除术后早期转归的影响

Effects of operation sequence on early outcomes of pancreaticoduodenectomy

目的分析手术台次对胰十二指肠切除术(Whipple手术)术中出血量和早期转归的影响。方法收集2017至2021年接受Whipple手术的胰腺癌患者519例,男306例,女213例,年龄32~86岁,BMI 15~35 kg/m^(2),ASAⅠ—Ⅲ级。依据手术台次分为两组:台次≤2组和台次>2组。将患者术中出血量作为主要观察指标,晶体输液量、胶体输液量,术后胰瘘、胆瘘、乳糜瘘、腹部出血、肺部感染、腹腔感染、胃排空障碍、发热等并发症发生率,术后住院时间为次要观察指标。采用Logistic回归分析手术台次与术中大出血和早期转归指标的相关性。结果共纳入患者519例,其中台次≤2组有415例(800%)。与台次≤2组比较,台次>2组术中大出血发生率明显增加(RR=1669,95%CI 1146~2430,P=0011)。两组晶体输液量、胶体输液量、住院期间胰瘘、胆瘘、乳糜瘘、腹部出血、肺部感染、腹腔感染、胃排空障碍、发热等术后并发症发生率和术后住院时间差异无统计学意义。多因素Logistic回归分析示术中大出血的危险因素为手术台次>2(OR=2269,95%CI 1318~3907,P=0003)和手术时间延长(OR=1012,95%CI 1009~1016,P<0001)。结论手术台次>2及手术时间延长会增加胰腺癌患者Whipple手术中发生大出血的风险,但对术后住院时间和住院期间术后并发症无明显影响。

Objective To retrospectively analyze the effects of sequence of pancreaticoduodenectomy(Whipple surgery)on bleeding in operation and early outcomes.Methods The medical records of 519 pan-creatic cancer patients,305 males and 213 females,aged 32 to 86,BMI 15-35 kg/m^(2),ASA physical sta-tusⅠ-Ⅲ,who underwent Whipple surgery from 2017 to 2021 were collected.According to the sequence of operation,the patients were divided into two groups:group≤2 and group>2.The primary outcome was hemorrhage during surgery.Secondary outcome was recorded including the crystalloid infusion volume,the colloid infusion volume,incidence of postoperative complications in-hospital consisting of pancreatic fistula,biliary fistula,chylous fistula,abdominal bleeding,pulmonary infection,abdominal infection,gastric emp-tying disorders,fever,and length of postoperative hospital stay.Logistic regression was applied to examine the relations between the sequence of operation and hemorrhage during surgery.Results A total of 519 pa-tients was included in the study.415 patients(800%)belonged to the group≤2 and 104 patients be-longed to the group>2.Compared with the group≤2,the incidence of major bleeding(RR=1669,95%CI 1146-2430,P=0011)in the group>2 was higher significantly.There was no significant differ-ence in the crystalloid infusion volume,colloid infusion volume,incidence of postoperative complications in-hospital consisting of pancreatic fistula,biliary fistula,chylous fistula,abdominal bleeding,pulmonary infec-tion,abdominal infection,gastric emptying disorders,fever,and length of postoperative hospital stay between the two groups.Logistic regression identified the sequence of operation>2(OR=2269,95%CI 1318-3907,P=0003)and the longer surgery time(OR=1012,95%CI 1009-1016,P<0001)as the risk factors for hemorrhage during operation.Conclusion The sequence of operation>2 and the longer surgery time increase the risk of major bleeding in Whipple surgery for pancreatic cancer,while it has no significant impact on the length of postoperative hospital stay and postoperative complications in-hospital.