远端胰腺切除术后并发症及死亡的危险因素分析  

Risk factors for postoperative complications and in-hospital death in distal pancreatectomy

作　　者：陈永亮[1] 黄志强[1] 董家鸿[1] 张文智[1] 黄晓强[1] 王彦斌[1] 陈明易[1] 刘志伟[1] 万涛[1] 

机构地区：[1]解放军总医院肝胆外科医院,北京100853

出　　处：《中华医学杂志》2015年第2期96-99,共4页National Medical Journal of China

摘　　要：目的 探讨远端胰切除术后并发症及死亡的相关危险因素.方法 回顾分析解放军总医院2000年8月至2010年8月期间接受远端胰腺切除术的连续223例患者的临床资料,分析其术后的并发症以及死亡的危险因素,进一步提高远端胰腺切除的手术安全性.结果 本组术后总并发症发生率为26.9％ （60/223）,死亡率为1.35％ （3/223）.胰瘘是最常见的并发症,发生率为19.3％（43/223）.单因素统计分析发现影响术后并发症发生的危险因素包括病变原发部位、手术时间、术中失血量、胰管封闭方式、脾切除以及联合多脏器切除.影响术后住院死亡的危险因素为手术时间和术中输血量.多元统计分析发现远端胰腺切除术后并发症发生的独立危险因素为手术时间长短;未发现术后住院死亡的独立危险因素.结论 手术时间过长是远端胰腺切除术后并发症发生的独立危险因素,其他相关指标对术后并发症及死亡无显著影响.Objective To explore the risk factors for postoperative complications and in-hospital death of distal pancreatectomy （DP）.Methods Retrospective reviews were conducted for 223 patients undergoing distal pancreatectomy.Their perioperative data and postoperative rates of morbidity and mortality were collected.And the risk factors for postoperative complications and in-hospital death were analyzed.Results The overall morbidity rate of distal pancreatectomy was 26.9% （60/223）.And mortality occurred in 3 patients （1.35%）.Pancreatic fistula was the most common complication with an incidence rate of 19.3%.Univariate analysis identified location of tumor,operative duration,estimated intraoperative blood loss,use of stapler,splenectomy and multivisceral resection were risk factors for post-DP complications.And operative duration and estimated intraoperative blood loss contributed to in-hospital death after DP.Multivariate analysis revealed that operative duration was an independent factor for increased postoperative complication rate.No independent factor was found for overall in-hospital morbidity.Conclusion Operative duration is an independent risk factor for postoperative complications.Other parameters have no significant effects on postoperative complications or overall in-hospital morbidity.

关 键 词：胰腺切除术 并发症 住院死亡 危险因素 

分 类 号：R657.5[医药卫生—外科学]