350例胰十二指肠切除术后并发症的相关危险因素分析  

Risk factors of complications after pancreatoduodenectomy in 350 patients

作　　者：张志磊 张萌[1] 彭利[1] 贾聿明 徐卓[1] 张冬胜[1] 唐瑞峰[1] 

机构地区：[1]河北医科大学第四医院肝胆外科,河北石家庄050011

出　　处：《中国现代医学杂志》2017年第26期75-78,共4页China Journal of Modern Medicine

基　　金：河北省医学科学研究重点课题计划(No:ZL20140079)

摘　　要：目的分析胰十二指肠切除术(PD)后并发症的相关危险因素。方法回顾性分析2010年1月-2013年12月在河北医科大学第四医院接受PD的350例患者临床资料,选取13个临床因素(年龄、性别、重要器官系统合并症、既往腹部手术史、血清白蛋白、血清总胆红素、血清谷丙转氨酶、糖类抗原199、手术时间、术中输血量、病灶部位、病灶直径、主胰管直径),分析其与术后并发症的相关性。采用Logistic回归分析筛选出与术后并发症相关的危险因素。结果单因素分析结果表明,年龄、重要器官系统合并症、术中输血量、病灶部位及主胰管直径是影响PD后并发症发生的危险因素(P<0.05);多因素分析结果表明,术后并发症独立危险因素为术中输血量、病灶部位及主胰管直径;术后胰瘘的独立危险因素为:主胰管直径;出血的独立危险因素为:血清总胆红素水平;术后感染的独立危险因素为:年龄、输血量、主胰管直径(P<0.05)。结论输血量、病灶部位及主胰管直径是影响PD后并发症的相关危险因素。Objective To investigate the risk factors of post-pancreatoduodenectomy complications.Methods The clinical data of 350 patients who underwent pancreatoduodenectomy in the Fourth Hospital of Hebei Medical University between January 2010 and December 2013 were retrospectively studied. The correlations of thirteen clinicopathological factors(age, gender, combined diseases of vital organs, history of abdominal surgery, ALB, TBIL, ALT, CA199, operative time, intraoperative blood transfusion, tumor location,tumor size and diameter of pancreatic duct) with the postoperative complications were studied. Logistic regression analysis was used to screen the related risk factors for postoperative complications. Results Univariate analysis showed that the major risk factors for postoperative complications were age, combined diseases of vital organs, intraoperative blood transfusion, tumor location and pancreatic duct diameter(P <0.05). Multivariate analysis showed that blood transfusion volume, tumor location and pancreatic duct diameter were the independent risk factors for complications after pancreatoduodenectomy; pancreatic duct diameter was the independent risk factor of pancreatic fistula; TBI was the independent risk factor of hemorrhage; age,blood transfusion volume and pancreatic duct diameter were the independent risk factors of postoperative infection(P < 0.05). Conclusions Postoperative complications of pancreatoduodenectomy are closely related to blood transfusion volume, tumor location and pancreatic duct diameter.

关 键 词：胰十二指肠切除术 并发症 危险因素 胰瘘 出血 感染 

分 类 号：R656[医药卫生—外科学]