摘要
目的分析胰十二指肠切除术手术并发症及影响胰瘘的危险因素。方法回顾性研究该院2000年1月至2009年12月同一术者施行的169例胰十二指肠切除术患者资料，分析影响胰瘘的危险因素，比较前5年与后5年间的并发症差异。结果死亡率2．4％，并发症发生率为34．9％，胰瘘发生率为7．7％；多变量Logistic回归分析提示手术出血量大于400ml（OR＝2．87；95％可信区间：1．17～8．19；P＝0．048）、胰腺质软（OR—1．95；95％可信区间：0．87～6．19；P＝0．032）和胰管直径小于3mm（OR＝3．78；95％可信区间：1．01～10．63；P=0．019）是影响术后发生胰瘘与否的危险因素；前5年与后5年患者临床资料在死亡率、并发症以及主要并发症发生率差异无统计学意义，后5年的再手术率较前5年高、术后住院天数显著延长。结论手术出血量、胰腺质地和胰管直径是影响术后发生胰瘘与否的危险因素；为减少术后胰瘘的发生，应选用术者熟悉的吻合方式进行胰肠吻合。
Objective To investigate the complications and the risk factors for pancreatic leakage after pancreaticoduodenectomy. Methods One hundred and sixty-nine patients who received pan- creaticoduodenectomy in our hospital between January 2000 and December 2009 were reviewed. Chisquare and logistic statistic analysis were performed to determine the risk factors for pancreatic leakage. The difference in complication rates between different periods were analyzed. Results The mortality was 2.4%. The morbidity was 34.9%, and the pancreatic leakage rate was 7.7%. Logistic analysis revealed significant risk factors for pancreatic leakage included intraoperative bleeding of more than 400 ml （OR=2.87; 95% confidence interval： 1.17--8.19; P=0. 048）, soft texture of remnant pancreas （OR= 1.95; 95 % confidence interval： 0.87--6.19; P=0. 032） and pancreatic duct diameter smaller than 3 mm （OR=3.78; 95% confidence interval： 1.01- 10.63; P=0. 019）. There was no significartt difference in mortality, morbidity, pancreatic leakage, and upper gastric bleeding between the periods 2000--2004 and 2005--2009. However, re-operation rate and postoperative hospital stay were significantly higher in the period of 2005--2009. Conclusions Intraoperative bleeding, soft texture of remnant pancreas and pancreatic duct diameter smaller than 3mm were significant risk factors for postoperative pancreatic leakage. A pancreaticojejunostomy anastomotic technique familiar to the surgeon might reduce postoperative pancreatic leakage.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2012年第3期184-187,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
胰十二指肠切除术
胰腺瘘
手术后并发症
Pancreaticoduodenectomy
Pancreatic fistula
Postoperative complications
