老年胰十二指肠切除术患者围术期安全性分析  

Perioperative safety of pancreaticoduodenectomy in elderly patients

作　　者：李喆[1] 许静涌[1] 贺修文[1] 乔江春[1] 宋京海[1] 陈剑[1] 韦军民[1] Li Zhe;Xu Jingyong;He Xiuwen;Qiao Jiangchun;Song Jinghai;Chen Jian;Wei Junmin(Department of General Surgery,Department of Hepato-bilio-pancreatic Surgery,Beijing Hospital,National Center of Gerontology,Insttute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院普通外科肝胆胰外科/国家老年医学中心/中国医学科学院老年医学研究院

出　　处：《中华老年医学杂志》2021年第6期752-755,共4页Chinese Journal of Geriatrics

基　　金：北京市科学技术委员会首都临床特色应用研究(Z181100001718216)。

摘　　要：目的:探讨老年患者行胰十二指肠切除术的围术期安全性。方法﹑回顾性分析2016年至2019年北京医院收治的152例行胰十二指肠切除术患者的临床资料。根据年龄分为老年组(年龄≥65岁)与非老年组(年龄<65岁)。比较两组术中及术后情况。结果老年组手术时间(352.7±69.5)min,术中出血量(708.7±672.7)ml,术中尿量(875.8±497.3)ml与非老年组(359.0±94.4)min,(662.6±896.7)ml,(1010.6±568.2)ml相比差异无统计学意义(均P>0.05)。老年组围术期死亡率、Clavien-Dindo分级Ⅲ级及以上并发症发生率、二次手术率分别为6.1%、21.2%、10.6%,非高龄组相应为1.2%、19.8%、8.1%,差异无统计学意义(χ^(2)=1.487,0.048,0.272,均P>0.05)。老年组手术操作相关并发症发生率,术后心脑血管意外发生率较非老年组差异无统计学意义(P>0.05)。两组术后住院时间分别为(28±19)d,(27±18)d,两者差异无统计学意义(t=0.187,P>0.05)。结论﹐老年患者行胰十二指肠切除术是同样安全的,年龄并非胰十二指肠切除术的禁忌证。术前针对老年患者更加全面的全身评估、术中精细操作及加强围术期管理十分必要。Objective To evaluate the perioperative safety of pancreaticoduodenectomy(PD)inelderly patients.Methods Clinical data of 152 patients undergoing PD in Beijing Hospital between 2016 and 2019 were retrospectively analyzed.According to the age,patients were divided into theelderly group(age≥65 years)and the non-elderly group(age<65 years).The perioperative andpostoperative parameters were compared between the two groups.Results There was no significantdifference in the operative time,intraoperative blood loss and intraoperative urine output between theelderly group and the non-elderly group(352.7±69.5)min vs.(359.0±94.4)min,(708.7±672.7)vs.(662.6±896.7)ml and(875.8±497.3)ml vs.(1010.6±568.2)ml,all P>0.05).Theperioperative mortality,postoperative complications(Clavien-Dindo classification≥gradeⅢ)andreoperation rate had no significant difference between clderly group and the non-elderly group(6.1%vs.1.2%,21.2%vs.19.8%,10.6%vs.8.1%,respectively,χ^(2)=1.487,0.048 and 0.272,all P>0.05).The incidences of operation-related complications,cardiovascular or cerebrovascular adverseevents in elderly group were comparable to non-elderly group(P>0.05).The postoperative hospitalstay had no significant difference between the elderly group and the non-elderly group[(28±19)d vs.(27±18)d,P>0.05].Conclusions PD is safe in elderly patients.Age is not a contraindication topancreaticoduodenectomy.The comprehensive systemic evaluation,intraoperative delicate operationand enhanced perioperative management are necessary in the elderly patients undergoing PD.

关 键 词：胰十二指肠切除术 手术期间 

分 类 号：R657.5[医药卫生—外科学]