POSSUM及其改良评分系统在胰十二指肠切除术风险评估中的临床应用价值

发布时间：2018-05-15 03:29

本文选题：POSSUM + P-POSSUM　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:通过回顾性研究分析胰十二指肠切除术后并发症及死亡的相关危险因素,探讨POSSUM及其改良的评分系统在预测胰十二指肠切除术手术风险中的临床应用价值。方法:收集2010年1月至2013年12月在河北医科大学第四医院肝胆外科行胰十二指肠切除术的病例350例,统计这些病例术前营养状况、全身的生理状态、重要脏器功能、围手术期准备、手术情况、胰腺条件、肿瘤的大小及部位、术后生长抑素的应用、POSSUM评分等指标,分析其与术后并发症及死亡的相关性。采用Logistic回归分析筛选出与术后并发症及死亡的相关危险因素。对350例病例资料进行POSSUM评分,通过评分计算出预测的并发症发生率及死亡率,与实际的并发症发生率及死亡率进行比较,观察预测值与实际值的契合程度。所有数据采用SPSS 21.0统计软件进行分析处理,单因素分析采用χ2检验,多因素分析采用Logistic回归分析。P0.05为差异有统计学意义。结果:本组350例胰十二指肠切除术患者术后发生并发症160例(45.71%)。其中死亡11例(3.14%),胰瘘47例(13.43%),出血37例(10.57%),胃排空延迟31例(8.86%),应激性溃疡22例(6.28%)、腹腔感染50例(14.28%),胸腔积液8例(2.28%)、腹腔积液5例(1.42%),肺炎11例(3.14%),胆瘘6例(1.71%)。经Logistic回归分析显示:年龄、体重、呼吸系统疾病、肿瘤体积、肿瘤部位、术后是否应用生长抑素是影响并发症发生的危险因素(P0.05)。350例行胰十二指肠切除术患者的生理学指标评分是12~34分,平均分值为18.53±4.28,手术严重性指标评分是14~24分,平均分值为16.33±1.89,总的POSSUM评分是26~58分,平均分值为34.85±4.82。POSSUM评分系统预测的并发症发生率是53.88%,实际的并发症发生率是45.71%,二者相比较,经χ2检验,P0.05,结果有统计学差异,POSSUM评分系统过高预测了患者术后的并发症发生率。POSSUM评分系统预测的死亡率是11.72%,实际的死亡率是3.14%,经χ2检验,P0.01,结果有统计学差异,也过高预测了患者术后的死亡率,P-POSSUM评分系统(用于预测死亡率的改良POSSUM评分系统)预测的死亡率是3.23%,经χ2检验,P0.05,结果无统计学差异,能比较准确地预测患者术后死亡率。结论:患者的年龄、体重、呼吸系统疾病、肿瘤体积、肿瘤部位、术后是否应用生长抑素是影响胰十二指肠切除术后并发症及死亡的相关危险因素。POSSUM评分系统预测胰十二指肠切除术患者的术后并发症发生率及死亡率均偏高,而改良的P-POSSUM评分系统能较好的预测患者术后死亡率,但不能很好的预测并发症发生率。POSSUM评分系统预测胰十二指肠切除术手术风险有一定的临床应用价值,但仍需进一步研究完善。
[Abstract]:Objective: to analyze the risk factors of complications and death after pancreaticoduodenectomy and to explore the clinical application value of POSSUM and its improved scoring system in predicting the risk of pancreatoduodenectomy. Methods: from January 2010 to December 2013, 350 cases of pancreaticoduodenectomy in the Department of Hepatobiliary surgery of the fourth Hospital of Hebei Medical University were collected. Perioperative preparation, surgical condition, pancreatic condition, tumor size and location, postoperative somatostatin application and possum score were analyzed to analyze the correlation with postoperative complications and death. Logistic regression analysis was used to screen the risk factors associated with postoperative complications and death. The incidence and mortality of complications were calculated and compared with the actual incidence of complications and mortality, and the degree of agreement between the predicted value and the actual value was observed. All data were analyzed by SPSS 21.0 software, 蠂 2 test was used for univariate analysis and Logistic regression analysis was used for multivariate analysis. Results: there were 160 cases of complications after pancreaticoduodenectomy in this group. Among them, 11 cases died, 47 cases had pancreatic fistula, 37 cases had hemorrhage, 37 cases had gastric emptying, 31 cases had delayed gastric emptying, 22 cases had stress ulcer, 22 cases had stress ulcer, 50 cases had intraperitoneal infection with 14. 28T, 8 cases had pleural effusion, 5 cases had abdominal effusion, 11 cases had pneumonia and 3.14%, 6 cases had bile fistula. Logistic regression analysis showed that age, body weight, respiratory diseases, tumor volume, tumor location, Postoperatively, somatostatin was a risk factor for complications. The physiological index scores of patients undergoing pancreaticoduodenectomy were 12 ~ 34 points, the average score was 18.53 卤4.28, and the operative severity score was 14 ~ 24 points. The average score was 16.33 卤1.89, the total POSSUM score was 26 ~ 58 points, the average score was 34.85 卤4.82.POSSUM scoring system, the predicted complication rate was 53.88 and the actual complication rate was 45.71. By 蠂 2 test, P 0.05, the results were statistically different. The incidence of postoperative complications was predicted by the possum scoring system. The mortality rate predicted by the possum scoring system was 11.72, and the actual mortality was 3.14. After 蠂 2 test, P 0.01, the results were statistically different. The mortality rate predicted by P-POSSUM scoring system (an improved POSSUM scoring system for predicting mortality) was 3.23%. 蠂 ~ 2 test showed that there was no statistical difference between the two groups and the postoperative mortality rate could be predicted more accurately. Conclusion: age, body weight, respiratory diseases, tumor volume, tumor location, Postoperatively, somatostatin was a risk factor for postoperative complications and death after pancreaticoduodenectomy. Possum scoring system was used to predict the incidence and mortality of postoperative complications in patients with pancreatoduodenectomy. The modified P-POSSUM scoring system can predict the postoperative mortality, but it can not predict the incidence of complications. Possum scoring system can predict the risk of pancreaticoduodenectomy. But it still needs further research and perfection.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656

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