胰十二指肠切除术后并发症相关因素分析

目的：探讨胰十二指肠切除术（pancreatoduodenectomy,PD）术后并发症及其危险因素。方法：回顾2000年至2009年第四军医大学西京医院258例行胰十二指肠切除术病人临床资料,并通过单因素分析和多因素分析术后并发症危险因素。结果：本组术后并发症发生率为22.1%（57/258）。多见的并发症包括胰漏、胆漏、腹腔感染,出血等。Logistic回归分析显示,与并发症有关的因素包括术前血清总胆红素〉171μmol/L、术前血清白蛋白〈30g/L,术中出血量〉800 ML,年龄〉60岁,术前血红蛋白〈100g/L。结论：术前血清总胆红素〉171μmol/L,术前血清白蛋白〈30g/L和术中出血量〉800 ML是胰十二指肠切除术术后并发症的高危因素,其次的危险因素为年龄〉60岁、术前血红蛋白〈100g/L。手术者应掌握好手术时机,加强围手术期处理,从而降低胰十二指肠切除术术后并发症。

Risk factors of complications after pancreatieoduodenectomy

Objective：To investigate the postoperative complications after pancreaticoduodenectomy and their relationships with clinical risk factors.Methods：The clinical data from 258 patients undergoing PD in Xijing Hospital from 2000 to 2009 was collected and the clinical risk factors of postoperative complications was investigated by Univariate and multivariate analysis.Results：The postoperative complication rate was 22.1%（57/258）.The general complications include pancreatic or biliary anastomotic leakage,abdominal infection and bleeding.Logistic regression analysis revealed that the clinical risk factors of postoperative complication including：preoperative total serum bilirubin level over 171 μmol/L,preoperative albumin less than 30g/L,blood-loss of during operate over 800 ml,age over 60 years,preoperative Hb less than 100g/L.Conclusions：preoperative total serum bilirubin level over 171 μmol/L,preoperative albumin less than 30g/L and blood-loss of surgery over 800 ml are the high risk factors of the postoperative complications of PD.over 60 years,preoperative Hb less than 100g/L are the minor risk factors of the postoperative complications of PD.The surgeon should predominate operative opportunity and enhanced perioperative management in order to reducing postoperative complications after PD.