【摘要】 目的多因素分析胰十二指肠切除(PD)术后并发症及死亡危险因素。方法233例行PD手术患者,平均年龄56岁;恶性病变210例,良性病变23例;胰头恶性肿瘤72例,壶腹周围恶性肿瘤138例。有重要器官系统合并症59例。根据病变部位分为胰腺组(81例)和壶腹周围组(152例)。结果术后发生并发症63例(27.0%),早期并发症58例(24.9%),感染并发症28例(12.0%),多器官功能障碍15例(6.4%),出血并发症14例(6.0%),胰瘘12例(5.2%),再手术15例(6.4%),住院死亡16例(6.9%)。多因素分析提示,术后并发症的独立危险因素有重要脏器合并症、手术方式、主胰管直径及手术者经验。住院死亡的独立危险因素有术前血Cr水平、重要脏器合并症及手术者经验。再手术的独立危险因素有术前CA19-9水平、手术者经验、病灶直径及淋巴结转移。胰瘘的独立危险因素有Whipple术式、主胰管直径及手术者经验。结论重要脏器合并症及手术者经验是PD术后并发症和住院死亡的独立危险因素;手术方式、主胰管直径及手术者经验是胰瘘的独立危险因素。因此,PD适应证及术式选择和技术的完善对于减少术后并发症及住院死亡至关重要。更多还原

【Abstract】 Objective To multifactorially analyze the risk factors related to the post-pancreaticoduodenectomy (PD)complications and death.Methods Two hundred and thirty-three PD cases were analyzed,average age 56,of those cases,210 malignant with 72 pancreatic head and 138 periampullary involvement,23 benign.Fifty-nine cases suffered coexisting vital organ disorders.Results Sixty-three cases(27.0%)experienced postoperative complica- tions,among those 58 cases(24.9%)early complications,28(12.0%)infection,15(6.4%)organ systemic disor- der,14(6.0%)bleeding,12(5.2%)pancreatic fistula,15(6.4%)reoperations,16 postoperative death during hos- pitalization.The independent risk factors related to the postoperative complications included coexisting vital organ disorders,operation methods,main pancreatic duct(MPD)diameter and surgeon’s experiences,those related to the death during hospitalization included preoperative serum creatinine,coexisting vital organ disorders,surgeon’s ex- periences;those related to the reoperation included preoperative CA19-9,surgeon’s experiences,tumor diameters, lymph nodes metastasis;and those related to the pancreatic fistula included operation methods,MPD diameters and surgeon’s experiences.Conclusion Coexisting vital organ disorders and surgeon’s experiences are the independent risk factors related to postoperative complications and death during hospitalization,operation methods,MPD diame- ter and surgeon’s experiences are the independent risk factors related to the pancreatic fistula.Thus,it is very im- portant to choose the appropriate PD candidates,select the right operation method and to familiarize the operation.更多还原