手术台次对胰十二指肠切除术后早期转归的影响  

Effects of operation sequence on early outcomes of pancreaticoduodenectomy

作　　者：黄少康 倪渊博 杨春 蒋奎荣 刘存明 Yuanbo;YANG Chun;JIANG Kuirong;LIU Cunming(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,210029 [2]南京医科大学第一附属医院胰腺中心,210029

出　　处：《临床麻醉学杂志》2024年第4期363-367,共5页Journal of Clinical Anesthesiology

摘　　要：目的分析手术台次对胰十二指肠切除术(Whipple手术)术中出血量和早期转归的影响。方法收集2017至2021年接受Whipple手术的胰腺癌患者519例,男306例,女213例,年龄32~86岁,BMI 15~35 kg/m^(2),ASAⅠ—Ⅲ级。依据手术台次分为两组:台次≤2组和台次>2组。将患者术中出血量作为主要观察指标,晶体输液量、胶体输液量,术后胰瘘、胆瘘、乳糜瘘、腹部出血、肺部感染、腹腔感染、胃排空障碍、发热等并发症发生率,术后住院时间为次要观察指标。采用Logistic回归分析手术台次与术中大出血和早期转归指标的相关性。结果共纳入患者519例,其中台次≤2组有415例(800%)。与台次≤2组比较,台次>2组术中大出血发生率明显增加(RR=1669,95%CI 1146~2430,P=0011)。两组晶体输液量、胶体输液量、住院期间胰瘘、胆瘘、乳糜瘘、腹部出血、肺部感染、腹腔感染、胃排空障碍、发热等术后并发症发生率和术后住院时间差异无统计学意义。多因素Logistic回归分析示术中大出血的危险因素为手术台次>2(OR=2269,95%CI 1318~3907,P=0003)和手术时间延长(OR=1012,95%CI 1009~1016,P<0001)。结论手术台次>2及手术时间延长会增加胰腺癌患者Whipple手术中发生大出血的风险,但对术后住院时间和住院期间术后并发症无明显影响。Objective To retrospectively analyze the effects of sequence of pancreaticoduodenectomy(Whipple surgery)on bleeding in operation and early outcomes.Methods The medical records of 519 pan-creatic cancer patients,305 males and 213 females,aged 32 to 86,BMI 15-35 kg/m^(2),ASA physical sta-tusⅠ-Ⅲ,who underwent Whipple surgery from 2017 to 2021 were collected.According to the sequence of operation,the patients were divided into two groups:group≤2 and group>2.The primary outcome was hemorrhage during surgery.Secondary outcome was recorded including the crystalloid infusion volume,the colloid infusion volume,incidence of postoperative complications in-hospital consisting of pancreatic fistula,biliary fistula,chylous fistula,abdominal bleeding,pulmonary infection,abdominal infection,gastric emp-tying disorders,fever,and length of postoperative hospital stay.Logistic regression was applied to examine the relations between the sequence of operation and hemorrhage during surgery.Results A total of 519 pa-tients was included in the study.415 patients(800%)belonged to the group≤2 and 104 patients be-longed to the group>2.Compared with the group≤2,the incidence of major bleeding(RR=1669,95%CI 1146-2430,P=0011)in the group>2 was higher significantly.There was no significant differ-ence in the crystalloid infusion volume,colloid infusion volume,incidence of postoperative complications in-hospital consisting of pancreatic fistula,biliary fistula,chylous fistula,abdominal bleeding,pulmonary infec-tion,abdominal infection,gastric emptying disorders,fever,and length of postoperative hospital stay between the two groups.Logistic regression identified the sequence of operation>2(OR=2269,95%CI 1318-3907,P=0003)and the longer surgery time(OR=1012,95%CI 1009-1016,P<0001)as the risk factors for hemorrhage during operation.Conclusion The sequence of operation>2 and the longer surgery time increase the risk of major bleeding in Whipple surgery for pancreatic cancer,while it has no significant impact on the length of postoperative

关 键 词：胰十二指肠切除术 胰腺癌 手术台次 手术时间 大出血 

分 类 号：R735.9[医药卫生—肿瘤]