术前黄疸水平对胰十二脂肠切除术的影响

发布时间：2018-06-05 08:30

  本文选题：梗阻性黄疸 + 胰十二指肠切除术　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:了解术前黄疸水平对胰十二指肠切除术的影响,探究术后并发症的相关危险因素。并探讨"可切除胰腺癌患者合并梗阻性黄疸"是否常规术前减黄的临床决策。方法:对浙江大学附属邵逸夫医院2010年1月至2016年10月74例术前有黄疸,并行胰十二指肠切除术的病例资料进行回顾性分析。其中,男48例,女26例,男女比例为1.846:1。年龄43-80岁(平均62.97±8.67岁)。术前黄疸水平36.7-719.3μmol/L(平均244.40±162.76μmol/L)。胰头癌74例,胰体尾癌0例。均行胰十二脂肠切除术(腹腔镜22例,开腹52例)。术前进行减黄操作6例(均为PTCD),未减黄68例。根据术前黄疸水平,将病人分为轻度黄胆组(171μmol/L)、中度黄胆组(171-342μmol/L)及重度黄胆组(342μmol/L),比较三个组的一般资料、围手术期指标、术后并发症、死亡率以及预后,了解术前黄疸水平对胰十二指肠切除术的影响。同时,分析术后并发症发生的相关危险因素,并比较术前减黄组与未减黄组的基本指标有无统计学差异。采用SPSS 22.0统计软件对数据进行统计学分析,统计中P值小于0.05被认为具有统计学意义。结果:不同黄疸水平在术中出血量上有显著性差异(P=0.008),中度黄疸组出血量显著多于轻度黄疸组和重度黄疸组。在性别、年龄、BMI、手术时间、TNM分期、住院时间、术后住院时间、住院费用上三组均无显著性差异(P0.05)。轻度、中度、重度黄疸组术后并发症及死亡率均无显著性差异(P0.05)。二元Logistic回归分析发现年龄≥65 岁(OR=16.002,95%CI:1.682-152.264,P=0.016)、男性(OR=10.036,95%CI:1.920-52.464,P=0.006)是术后并发症发生的两个独立危险因素。术后并发症与术前总胆红素水平及术前直接胆红素水平并没有相关性(P0.05)。轻度黄疸组中位生存时间为8.9月,中度黄疸组中位生存时间为12.9月,重度黄疸组中位生存时间为12.1月,三者不具有统计学差异(P=0.678)。术前减黄组与未减黄组在BMI、手术时间、术中出血量、住院时间、术后住院时间、住院费用、术后并发症及死亡率上均无统计学意义(P0.05)。结论:术前黄疸水平对胰十二指肠切除术的影响不大,术前减黄价值有限,应根据病人的全身状况、治疗方案,以及是否有黄疸相关症状等选择性进行。
[Abstract]:Objective: to investigate the influence of preoperative jaundice on pancreaticoduodenectomy and explore the risk factors of postoperative complications. To explore the clinical decision of "resectable pancreatic cancer patients with obstructive jaundice" before operation. Methods: the data of 74 patients with jaundice and pancreaticoduodenectomy from January 2010 to October 2016 in run Shaw Hospital affiliated to Zhejiang University were analyzed retrospectively. Of these, 48 were males and 26 were females, with a ratio of 1.846: 1. The age ranged from 43 to 80 years (mean 62.97 卤8.67 years). Preoperative jaundice levels were 36.7-719.3 渭 mol / L (mean 244.40 卤162.76 渭 mol / L). There were 74 cases of pancreatic head carcinoma and 0 cases of pancreatic body and tail carcinoma. All patients underwent cholecystectomy (22 cases by laparoscopy and 52 cases by laparotomy). Preoperative yellow reduction operation was performed in 6 cases (all PTCDD, 68 cases without yellow reduction. According to the preoperative jaundice level, the patients were divided into mild yellow bile group (171 渭 mol / L / L), moderate yellow bile group (171-342 渭 mol / L) and severe yellow bile group (342 渭 mol / L). The general data, perioperative parameters, postoperative complications, mortality and prognosis were compared among the three groups. To investigate the effect of preoperative jaundice on pancreaticoduodenectomy. At the same time, the risk factors of postoperative complications were analyzed. The statistical data were analyzed by SPSS 22. 0 statistical software. The P value less than 0. 05 was considered to be statistically significant. Results: there was significant difference in the amount of intraoperative bleeding among different jaundice levels. The amount of bleeding in moderate jaundice group was significantly higher than that in mild jaundice group and severe jaundice group. There was no significant difference in sex, age, TNM stage, hospitalization time, postoperative hospitalization time and hospitalization cost among the three groups (P 0.05). There was no significant difference in postoperative complications and mortality among mild, moderate and severe jaundice groups (P 0.05). The binary Logistic regression analysis showed that the two independent risk factors of postoperative complications were the age 鈮，

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