129例胰十二指肠切除术的临床分析

发布时间：2018-04-18 19:03

本文选题：胰十二指肠切除术 + 并发症　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:通过对经PD患者的病历进行回顾性研究,探讨与胰十二指肠切除术后早期主要的并发症及死亡有关的危险因素,为降低并发症发生率、病死率和临床工作提供帮助。方法:回顾性分析山大二院、三院于2009.6-2014.6,根据排除标准纳入研究对象的129例行胰十二指肠切除术(PD)患者的临床资料。129例患者中,其中女性49例(38.0%),男性80例(62.0%),年龄22~79岁,平均年龄56.1岁。将性别、年龄(=65岁)、术前是否合并其他并发症(主要指高血压、糖尿病、心脏疾病)、术前白蛋白水平(=35g/L)、术前血总胆红素水平(=171umol/L)、术前黄疸持续时间(=30天)、手术时间(=6h)、术中失血量(=1000ml)、胰腺质地、胰肠吻合方式、是否留置胰管支撑管、主胰管直径(=3mm)、肿瘤部位、肿瘤大小、肿瘤性质15项指标作为研究对象。设计表格将可能影响术后早期并发症(胰瘘、胆瘘、出血、感染(主要包括肺部感染、腹腔感染)、胃排空障碍、多器官功能障碍综合征、切口感染)的危险因素进行两分类单因素分析,再将各单因素进行Logistic多因素回归分析(P0.05)。评价PD术后早期并发症的发生情况及其相关危险因素。结果:本组129例PD术患者中,术后1个月内出现主要并发症者有58例(45.0%),其中胰瘘32例(24.8%)、感染31例(24.0%)、出血13例(10.1%)、胆瘘12例(9.3%)、切口感染11例(8.5%)、胃排空功能障碍10例(7.8%)、MODS3例(2.3%)、死亡6例(4.7%)。统计学分析表明,单因素分析后术前总胆红素、术中出血量及肿瘤性质与术后早期并发症的发生呈相关性(P0.05,且OR1);将所选15个独立危险因素通过logistic前进法进行多变量分析得:术中出血量、主胰管直径和肿瘤性质是影响胰十二指肠切除术后早期主要并发症发生率的独立危险因素;术中出血量是胆瘘和出血发生的独立危险因素;术前黄疸持续时间、术中出血量及主胰管直径是胰瘘发生的独立危险因素;术前总胆红素水平是感染发生的独立危险因素(所有P0.05)。结论:胰十二指肠切除术仍是一项的高风险的手术,术后早期并发症的发病率仍较高,病死率有所降低,死亡的主要原因是各种并发症诱发的多器官功能障碍综合征及腹腔感染、出血。术中出血量达到1000ml以上、主胰管直径较小以及恶性肿瘤患者的PD术后并发症发生率和病死率更高。术中出血量超过1000ml可增加PD术后胆瘘及出血发生的风险。术前黄疸持续时间、术中出血量及主胰管直径是PD术后胰瘘发生的独立危险因素。术前总胆红素水平的高低影响了PD术后感染并发症的发生率。年龄并未影响PD术后各并发症的发生率。
[Abstract]:Objective: to investigate the risk factors related to the early complications and death after pancreaticoduodenectomy through a retrospective study of the medical records of patients with PD, in order to reduce the incidence of complications, mortality and clinical work.Methods: retrospective analysis was made on the clinical data of 129 patients with PDD who underwent pancreaticoduodenectomy according to the exclusion criteria. Among them, 49 were female (38.0%) and 80 were male (62.0). The age was 22 ~ 79 years old.The average age is 56.1 years.Sex, age, age of 65 years, preoperative complications (mainly hypertension, diabetes,Heart disease, preoperative albumin level is up to 35g / L, preoperative total bilirubin level is 171umoll / L, preoperative jaundice duration is 30 days, operation time is up to 6hs, intraoperative blood loss is less than 1000ml / L, pancreas texture, pancreaticojejunostomy mode, whether pancreatic duct support tube is retained.The diameter of the main pancreatic duct was 3 mm, tumor location, tumor size and tumor nature were studied.The design form may affect early postoperative complications (pancreatic fistula, biliary fistula, bleeding, infection (mainly pulmonary infection, abdominal infection, gastric emptying disorder, multiple organ dysfunction syndrome).The risk factors of incisional infection were analyzed by two classification single factor analysis, and the Logistic multivariate regression analysis was performed on each single factor (P 0.05).To evaluate the incidence and risk factors of early postoperative complications after PD.Results: of the 129 PD patients, 58 had major complications within one month, including 32 cases with pancreatic fistula, 24. 8%, 31 cases with pancreatic fistula, 24. 0%, 13 cases with hemorrhage, 12 cases with bile fistula, 11 cases with incision infection, 11 cases with incision infection, 10 cases with gastric emptying dysfunction and 3 cases with MODS, and 6 cases died.Statistical analysis showed that the total bilirubin before operation after univariate analysis,There was a correlation between the intraoperative bleeding volume and tumor nature and the occurrence of early postoperative complications (P 0.05 and OR1). The results of multivariate analysis of 15 independent risk factors by logistic were as follows: intraoperative bleeding volume;The diameter of the main pancreatic duct and the nature of the tumor were independent risk factors affecting the incidence of major complications after pancreaticoduodenectomy, the amount of intraoperative bleeding was an independent risk factor for biliary fistula and hemorrhage, and the duration of preoperative jaundice,Intraoperative bleeding and diameter of the main pancreatic duct were independent risk factors for pancreatic fistula, and preoperative total bilirubin level was an independent risk factor for infection (all P 0.05).Conclusion: pancreaticoduodenectomy is still a high-risk operation, the incidence of early postoperative complications is still high, and the mortality is lower.The main causes of death are multiple organ dysfunction syndrome, abdominal infection and hemorrhage induced by various complications.The incidence and mortality of postoperative complications in patients with malignant tumor were higher than that of 1000ml, the diameter of the main pancreatic duct was small and the incidence of postoperative complications was higher in patients with malignant tumor.Intraoperative bleeding over 1000ml increased the risk of biliary fistula and bleeding after PD.Preoperative jaundice duration, intraoperative bleeding volume and main pancreatic duct diameter were independent risk factors for pancreatic fistula after PD.The preoperative level of total bilirubin affected the incidence of postoperative infection complications.Age did not affect the incidence of complications after PD.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.6

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