腹腔镜下胰十二指肠切除术在高龄患者的围手术期安全性研究  

Study of perioperative safety of laparoscopic pancreaticoduodenectomy in elderly patients

作　　者：冯道夫 王义增[1] 李吉喆 李宝柱[1] 李楠[1] Feng Daofu;Wang Yizeng;Li Jizhe;Li Baozhu;Li Nan(Department of General Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院普通外科,天津300052

出　　处：《中华危重病急救医学》2023年第10期1063-1069,共7页Chinese Critical Care Medicine

基　　金：国家自然科学基金面上项目(62273186);天津市卫生健康科技项目科技人才培育项目(KJ20037)。

摘　　要：目的:探讨高龄患者行腹腔镜下胰十二指肠切除术(LPD)的安全性,及LPD术后入住重症监护病房(ICU)的危险因素。方法:采用回顾性研究方法,收集2017年2月至2023年6月天津医科大学总医院接受LPD患者的围手术期资料,包括基本资料、术前化验指标、术中及术后指标、病理结果(肿瘤大小、淋巴结清扫和病理类型)、术后并发症、ICU术后管理及预后等。根据年龄将患者分为老年组(≥65岁)和非老年组(<65岁)。比较两组患者的围手术期资料;绘制Kaplan-Meier生存曲线分析老年组与非老年组以及胰头腺癌组与其他类型癌组恶性肿瘤患者LPD术后的生存率;采用Logistic回归分析高龄患者LPD术后滞留ICU(ICU住院时间>1 d)的危险因素,并绘制受试者工作特征曲线(ROC曲线)分析该危险因素对高龄患者LPD术后滞留ICU的预测价值。结果:共纳入160例患者,其中老年组57例(血管重建17例)、非老年组103例(血管重建40例),均为R0切除,术后均转至综合ICU治疗;恶性肿瘤患者随访时间为43(6,72)个月。老年组手术时间、术后住院时间和经口进食时间明显长于非老年组,胃排空延迟(DGE)发生率明显高于非老年组,而两组患者术中输血率、术中出血量、病理结果、术后短期及严重并发症发生率、二次手术率和90 d病死率等比较差异均无统计学意义。血管重建患者中,老年组术中出血量较非老年组明显增多,手术时间和术后住院时间明显延长。ICU住院期间,与非老年组比较,老年组入ICU 24 h内急性生理学与慢性健康状况评分Ⅱ〔APACHEⅡ(分):12(9,14)比8(7,10)〕、序贯器官衰竭评分〔SOFA(分):6(4,8)比3(2,5)〕明显升高(均 P<0.05),机械通气时间〔h:12(10,15)比9(5,13)〕和ICU住院时间〔d:2(1,2)比1(1,1)〕明显延长(均 P<0.05),多学科协作诊疗(MDT)比例也明显升高(33.3%比17.4%, P<0.05),而两组血红蛋白(Hb)、白蛋白、乳酸水平差异无统计学意义�ObjectiveTo investigate the safety of laparoscopic pancreaticoduodenectomy(LPD)in elderly patients and the related risk factors admitted to the intensive care unit(ICU)after LPD.MethodsThe perioperative data of patients who underwent LPD in Tianjin Medical University General Hospital from February 2017 to June 2023 were retrospectively collected,including basic data,preoperative laboratory indicators,intraoperative and postoperative indicators,pathological results(tumor size,lymph node dissection and pathological type),postoperative complications,ICU postoperative management and prognosis.The patients were divided into the elderly group(≥65 years)and the non-elderly group(<65 years)according to age.Perioperative data between two groups were compared.Kaplan-Meier survival curve was drawn to analyze the survival rate of the elderly group and the non-elderly group,and the pancreatic head carcinoma group and other type of tumors group after LPD.Logistic regression was used to analyze the risk factors of ICU stay(length of ICU stay>1 day)after LPD in elderly patients.The receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of this risk factor for ICU stay after LPD in elderly patients.ResultsA total of 160 patients were enrolled,including 57 cases in the elderly group(17 cases of vascular reconstruction)and 103 cases in the non-elderly group(40 cases of vascular reconstruction).All patients underwent R0 resection and were transferred to the comprehensive ICU for treatment.The follow-up time of patients with malignant tumors was 43(6,72)months.The elderly group had significantly longer surgery time,postoperative hospital stay and oral feeding time than the non-elderly group,and the incidence of delayed gastric emptying(DGE)was significantly higher than that in the non-elderly group.There were no significant differences in intraoperative blood transfusion rate,intraoperative blood loss,pathological results,short-term and severe postoperative complications,reoperation rate and 90-d

关 键 词：高龄患者 胰十二指肠切除术 腹腔镜手术 重症监护 临床疗效与安全性 生存率 

分 类 号：R657.5[医药卫生—外科学]