壶腹周围恶性肿瘤手术并发症的临床分析

Clinical analysis of postoperative complications for periampullary malignant tumors

目的分析壶腹周围恶性肿瘤的手术并发症及其相关因素。方法回顾性分析1980年1月至2000年1月间收治的454例壶腹周围恶性肿瘤患者的临床资料。结果有81例(17.8%)患者出现手术并发症(包括手术死亡4例)。切除性手术的并发症发生率(28.4%)显著高于非切除性手术者(12.0%)(P<0.001)。经Logistic回归分析发现,外科治疗后是否出现手术并发症与年龄(P=0.013)、性别(P=0.0010)、肿瘤部位(P=0.047)和手术方式(P=0.0007)显著相关。非切除性手术患者的性别(P=0.010)、白细胞计数(P=0.028)和肿瘤部位(P=0.0079)是与术后并发症有显著意义的相关因素;切除性手术患者的年龄(P=0.012)、性别(P=0.0055)、转氨酶水平(P=0.023)与手术并发症显著相关。结论年龄、性别、肿瘤部位和手术方式是壶腹周围恶性肿瘤手术并发症的主要影响因素。白细胞计数显著影响非切除性手术并发症的发生率;转氨酶水平显著影响切除性手术并发症的发生率。

Objective To generalize postoperative complications of periampullary malignancies and analyze their related factors. Methods Four hundred and fifty four patients with periampullary malignant tumor underwent operation from Jan.1980 to Jan.2000 and clinical data were analyzed retrospectively. Results Among 454 patients with periampullary malignant tumor, 292 underwent non resectable operation and 162 tumor resection. The postoperative morbidity rate was 17 8%(n=81),including 4 cases (0 9%) of postoperative death. The postoperative morbidity rate was significantly higher in the patients after tumor removal(28 4%,46/162) than that in those receiving non resectable surgery(12.0%,35/292)(P< 0 001,χ2 test). Multivariate Logistic regression analysis revealed that age(OR=1.04,P=0.013),sex(OR=2 77, P=0 001), tumor original site(OR=1 33, P=0 047) and surgical method(OR=2 86, P=0 0007) were significantly correlated to postoperative morbidity rate. Sex (OR=4 57, P=0 010), white cell count(OR=2 86,P=0 028),and tumor original site(OR=1 70,P=0 0079) were independent factors for morbidity rate in the patients receiving palliative surgery, while age (OR=1 06, P=0 012), sex(OR=3 58, P=0 0055), ALT level (OR=3 36, P=0 023) were significantly correlated to postoperative morbidity rate in the patients after tumor resection. Conclusions Age, sex, tumor site and surgical method are the major factors correlated to postoperative morbidity after surgery for periampullary malignancies. Furthermore, white cell counts may be correlated to postoperative morbidity after non resectable operation, while ALT level affects postoperative morbidity after tumor resection.