胰十二指肠切除术后围手术期死亡原因分析

An analysis of causes for perioperative death after pancreaticoduodenectomy.

目的 分析胰十二指肠切除术后围手术期死亡的常见原因和探讨降低其死亡率的防治措施。方法 回顾性分析我院1961年6月至2002年6月胰十二指肠切除术后死亡病例资料。结果 共有307例患者施行了胰十二指肠切除术,术后有21例患者死亡,死亡率为6.8％。以1986年为界将行胰十二指肠切除术患者分为2个阶段,手术死亡率第1阶段为14.7％(11/75),第2阶段为4.3％(10/232)(P<0.01)。死亡原因为消化道出血(5例)、腹腔内出血(5例)、胰瘘(4例)、多器官功能衰竭(3例),ARDS(2例),腹腔感染(1例)及胆瘘(1例)。结论 胰十二指肠切除术后围手术期死亡的主要原因是消化道或腹腔内出血、胰瘘、多器官功能衰竭等。加强围手术期处理,术前进行重要脏器功能的合理评估,配备具有丰富经验的专科医生和完善外科操作技术,提高严重并发症的处理水平,可显著降低胰十二指肠切除术的围手术期死亡率。

Objective To analyze common causes for perioperative death after pancreaticoduode-nectomy (PD) and explore preventive and therapeutic measures to reduce mortality. Methods Clinical data of 307 patients who underwent PD in our department from June, 1961 to June, 2002 were studied retrospectively. Of these 307 patients, 21 died during 30 days postoperation. Results Operative mortality was 6. 8%. The operative mortality was 14. 7% (11/75) before 1986, and 4. 3% (10/232) afterwards, the difference being significant (P < 0. 01 ). The common causes of death during perioperation were intraabdominal and gastrointestinal hemorrhage, pancreatic leakage, MOF, ARDS, intraabdominal abscess and bile leakage. Conclusions Factors contributing to the decreased perioperative mortality include appropriate preoperative evaluation of functions of vital organs, intensified perioperative treatment, improved surgical skills, perfected techniques and higher level of managing severe complications.