基于统一定义分析胰十二指肠切除术后腹部并发症的危险因素  

Analysis of risk factors of intra-abdominal complications after pancreaticoduodenectomy based on an uniform definition

作　　者：肖卫东[1] 李勇[1] 蔡军[1] 李学明[1] 余永欢[1] 武彪[1] 揭志刚[1] 

机构地区：[1]南昌大学第一附属医院普通外科,江西南昌330006

出　　处：《中国现代医学杂志》2012年第6期61-64,共4页China Journal of Modern Medicine

摘　　要：目的基于统一定义分析胰十二指肠切除(PD)术后腹部并发症的危险因素。方法回顾性分析我院2001年1月～2010年7月间295例PD术的临床资料,采用国际胰腺外科研究协作组和中华医学会外科学分会胰腺外科学组制定的标准诊断腹部并发症,并用Logistic多因素回归分析腹部并发症的危险因素。结果总的腹部并发症发生率为45.4%,病死率为3.4%,再手术率为5.1%。胃排空延迟49例(16.6%),胰瘘37例(12.5%),出血18例(6.1%),腹腔感染16例(5.4%),切口感染或裂开8例(2.7%),胆瘘4例次(1.4%),胃肠吻合口瘘1例(0.3%),不全性肠梗阻1例(0.3%)。Logistic多因素回归分析结果显示,胰腺质地(OR=3.310)和胰管直径(OR=2.278)是胰瘘的独立危险因素;胰瘘(OR=2.945)和术前高胆红素水平(OR=1.062)是出血的独立危险因素;胰瘘(OR=2.104)和腹腔感染(OR=1.326)是B/C级胃排空延迟的独立危险因素;消化道瘘(OR=1.965)是腹腔感染的独立危险因素。结论临床上推行统一定义来评价PD术后并发症,有助于并发症的诊治,也有利于学术交流。针对各自危险因素,采取有效的预防措施,有望减少PD术腹部并发症的发生。[ Objective ] To investigate the intra-abdominal complications （IACs） and its main risk factors after pancreaticoduodenectomy （PD） based on an uniform definition. [ Methods ] A retrospective analysis was made on 295 cases who underwent PD from Janunary 2001 to July 2010. The diagnosis of IACs was based on an uniform def- inition suggested by International Study Group of Pancreatic Surgery and Pancreatic Surgery Group of Chinese Med- ical Association Surgery Branch, and the risk factors of IACs were analyzed by multivariate logistic regression anal- ysis. [Results] The overall rate of IACs was 45.4%. The overall mortality was 3.4% and the re-laparotomy rate was 5.1%. The IACs included 49 （16.6%） cases of delayed gastric emptying, 37 （12.5%） pancreatic fistula, 18 （6.1%） hemorrhage, 16 （6.1%） intra-abdominal infection, 8 （3.4%） incision infection or dehiscence, 4 （1.4%） bile leakage, 1 （1.4%） gastrointestinal fistula and 1 （1.4%） ileus. In multivariate analysis, pancreatic duct diameter （OR=3.310） and parenchyma texture （OR=2.278） were independent risk factors for pancreatic fistula, pancreatic fistula （OR=2.945） and high serum bilirubin level （OR=1.062） were independent risk factors for hemorrhage, pancreatic fistula （OR= 2.104） and intra-abdominal infection （OR=1.326） were independent risk factors for B/C grade delayed gastric empty- ing, and digestive tract fistula＂ （OR=1.965） was independent risk factor for intra-abdominal infection. [ Conclusion ]The usage of uniform definition is useful for the diagnosis and treatment of complications after PI）, and benefit for a- cademic exchange. Effective prevention aimed at its risk factors is helpful to decrease IACs after PD.

关 键 词：胰十二指肠切除术 手术并发症 危险因素 

分 类 号：R657[医药卫生—外科学]