胰腺切除术后常见并发症的临床因素分析  

Analysis of clinical risk factors with common operative complications after pancreatectomy

作　　者：沈红波 傅德良[2,3] 蒋永剑[2,3] 狄杨[2,3] 李骥[2,3] 姚冽[2,3] 杨峰[2,3] 金忱[2,3] 罗剑锋[4] 

机构地区：[1]浙江省衢州市中医院外科,浙江衢州324002 [2]复旦大学附属华山医院胰腺外科 [3]复旦大学胰腺病研究所,上海200040 [4]复旦大学公共卫生学院卫生统计与社会医学教研室,上海200032

出　　处：《外科理论与实践》2012年第5期481-485,共5页Journal of Surgery Concepts & Practice

基　　金：上海市科委重点科技攻关计划(08411954300)

摘　　要：目的:分析胰腺切除术后并发症的发生率,探讨胰腺切除术后常见并发症的临床因素及预防对策。方法:回顾性分析2008年12月到2009年6月间复旦大学附属华山医院142例胰腺切除手术后发生的常见并发症及其临床相关因素,采用Logistic回归法分析各因素与胰漏、胃排空延迟(delayed gastric emptying、DGE)、胰周感染发生的相关性。结果:本组病人围手术期并发症总的发生率为45.8%(65/142例),术前是否减黄与胰漏相关,前白蛋白、手术时间、术中出血量、输血量与术后DGE发生正相关(P=0.001、0.035、<0.001、<0.001)。体质量指数(body mass index,BMI)、术中出血量、输血量与胰周感染呈负相关(P=0.016、0.003、0.001)。Logistic回归分析发现术中出血量和输血量是DGE的危险因素,BMI和输血量是胰周感染的危险因素。结论:术前减黄能减少术后胰漏的发生,减少术中出血能降低DGE的发生,肥胖病人易发生胰周感染。Objective To summarize the complication rate of pancreatectomy, and investigate the risk factors related to common complications postpancreatectomy and preventive measures. Methods The common postoperative complications and clinical risk factors of 142 cases with pancreatectomy in Huashan hospital, Fudan University from Dec 2008 to Jun 2009 were analyzed retrospectively. The correlation of risk factors with pancreatic fistula, delayed gastric emptying （DGE）, peripancreatic infection were studied with Logistic regression. Results The total incidence of postperative complication was 45.8% （65/142）. Chi-square test, t-test showed that relief of preoperative jaundice was correlated with postoperative pancreatic fistula. The DGE was positively correlated with the albumin, operation time, the volume of hemorrhage, the volume of blood transfusion（P=0.001, 0.035, 〈0.001, 〈0.001 ）. The peripancreatic infection was positively correlated with BMI, the volume of hemorrhage and the volume of blood transfusion （P=0.016, 〈0.003, 0.001 ）. The volume of intraoperative hemorrhage and blood transfusion was the risk factor of DGE, BMI and, the volume of intraoperative hemorrhage was the risk factor of peripancreatie infection by analysis of multivariate Logistic regression. Conclusions Relief of preoperative jaundice may decrease the pancreatic fistula, control of intraoperative blood loss and less operation time may reduce the DGE, the obese patients are easy to have peripanereatie infection.

关 键 词：胰腺切除术 胰漏 胃排空延迟 胰周感染 术后并发症 

分 类 号：R735.9[医药卫生—肿瘤]