胰十二指肠切除患者术前营养状况与预后的相关分析

发布时间：2018-06-21 00:40

本文选题：胰十二指肠切除 + 营养状况　；参考：《广西医科大学》2016年硕士论文

【摘要】：目的：探讨胰十二指肠切除患者术前营养状况与预后的关系,寻找改善患者预后的途径。方法：回顾性分析2003年1月至2014年12月我院收治的102例胰十二指肠切除患者的临床病例资料。对包括8种营养指标在内的20种可能影响术后生存率的因素分别进行单因素和多因素Cox回归分析；对可能影响术后并发症发生率的8种营养指标进行logistic多因素回归分析。结果：本组102例患者全部完整随访,1年、3年总生存率分别为76.6%和26.8%,中位生存时间为16.9个月。47例患者术后出现2级及以上并发症,发生率为46.1%；其中,胰瘘21例(7例同时合并腹腔感染),发生率为23.5%；胆瘘5例(同时合并腹腔感染2例),发生率为4.9%；胃排空延迟6例,发生率为5.9%；术后出血8例,发生率为7.8%；腹腔感染者16例,发生率为15.7%；围手术期死亡2例,死亡率为2.0%。单因素分析结果显示：NRS2002、Onodera's PNI、血浆白蛋白水平是胰十二指肠切除患者的预后影响因素P0.08,多因素分析显示：Onodera's PNI和NRS2002是其预后的独立影响因素(P0.05)；logistic多因素回归分析提示：Onodera'sPNI、血浆白蛋白水平和体质指数是术后并发症的独立影响因素(P0.05),而Onodera's PNI和血浆白蛋白水平是术后胰瘘的独立影响因素(P0.05)。结论：Onodera's PNI和NRS2002是胰十二指肠切除患者预后的独立影响因素,Onodera's PNI、血浆白蛋白水平和体质指数是术后并发症的独立影响因素,Onodera's PNI和血浆白蛋白水平是术后胰瘘的独立影响因素；胰十二指肠切除术前应进行营养评估,对营养不良及存在营养风险的患者,应加强围手术期营养支持治疗。
[Abstract]:Objective: To explore the relationship between preoperative nutritional status and prognosis in patients with pancreatoduodenectomy and to find ways to improve the prognosis of patients. Methods: a retrospective analysis of the clinical data of 102 patients with pancreatoduodenectomy from January 2003 to December 2014 was reviewed. 20 kinds of nutritional indicators, including 8 kinds of nutritional indicators, could affect the survival rate. The factors of single factor and multi factor Cox regression analysis were carried out respectively. Logistic multiple factor regression analysis was used for the 8 nutritional indexes that may affect the incidence of postoperative complications. Results: all 102 patients in this group were followed up completely, 1 years, 3 years' total survival rate was 76.6% and 26.8% respectively, and the median survival time was 16.9 months after the operation of.47 patients. The incidence of complications of grade 2 and above was 46.1%, of which 21 cases of pancreatic fistula (7 cases combined with abdominal infection) were 23.5%, 5 cases of biliary fistula (including 2 cases with abdominal infection), 4.9%, 6 gastric emptying delay, 5.9%, 8 postoperative hemorrhage, 7.8%; peritoneal infection 16 cases, incidence rate of 5.9%; perioperative perioperative period; perioperative perioperative period; perioperative perioperative period; perioperative perioperative period; perioperative perioperative period; perioperative perioperative period; perioperative perioperative period; perioperative perioperative period; perioperative perioperative period; perioperative perioperative 2 cases of death with 2.0%. single factor analysis showed that NRS2002, Onodera's PNI, plasma albumin level were the prognostic factors of patients with pancreatoduodenectomy, P0.08. Multivariate analysis showed that Onodera's PNI and NRS2002 were independent prognostic factors (P0.05); logistic multiple factor regression analysis suggested that Onodera'sP: Onodera'sP NI, plasma albumin level and body mass index are independent factors of postoperative complications (P0.05), and Onodera's PNI and plasma albumin levels are independent factors of postoperative pancreatic fistula (P0.05). Conclusion: Onodera's PNI and NRS2002 are independent factors affecting the prognosis of patients with pancreatoduodenectomy, Onodera's PNI, plasma albumin level and Body mass index (BMI) is an independent factor in postoperative complications. Onodera's PNI and plasma albumin level are independent factors for postoperative pancreatic fistula; nutritional assessment should be performed before pancreatoduodenectomy. Perioperative support treatment should be strengthened for patients with malnutrition and nutritional risk.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.5

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