胰体尾切除术后早期并发症的临床观察

发布时间：2018-07-14 20:22

【摘要】：目的:探讨胰体尾切除术后早期并发症的相关危险因素,为临床医师提供借鉴,预防和减少胰体尾切除术后并发症的发生。方法:回顾性分析2008年4月至2014年11月入住福建医科大学附属协和医院,根据排除标准纳入研究对象的60例胰体尾切除术(DP)患者的临床资料。将年龄、性别、体重指数(BMI)、预后营养指数(PNI)、术前高血压、术前糖尿病、术前高脂血症、正常胰腺组织CT值、术后病理、手术耗时、术中出血、手术方式(开放/腔镜、切脾/保脾)、肿物与周围组织粘连情况、术后胃排空延迟(DGE)、术后胰瘘(POPF)、术后腹腔感染、术后肺部感染等18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(PF、腹腔感染、肺部感染、术后DGE)的危险因素进行两分类单因素分析。最后将各单因素分析中有意义项进行Logistic多因素回归分析,评价DP术后并发症的发生情况及其危险因素。结果:1.本组60例病例中45出现术后并发症,发生率为75.0%。其中术后胰瘘42例,发生率70.0%;腹腔感染19例,发生率31.7%;术后DGE 30例,发生率50.0%;肺部感染13例,发生率21.7%;1例死于术后严重腹腔感染、肝功能衰竭,死亡率1.7%。2.女性、腹腔感染为影响DP术后胰瘘的独立危险因素(P0.05);年龄≥60岁、腹腔感染为影响DP术后CR-PF的独立危险因素(P0.05);年龄≥60岁、糖尿病、肿物与周围组织粘连明显、术后DGE、术后发生PF及CR-PF为影响DP术后腹腔感染的独立危险因素(P0.05);年龄≥60岁、恶性肿瘤、肿物与周围组织粘连明显、术后发生腹腔感染是影响DP术后DGE的独立危险因素(P0.05);手术时间≥4h、术中出血≥300ml、术后发生胰瘘、腹腔感染为影响DP术后肺部感染的独立危险因素(P0.05)。上述7个独立危险因素通过Logistic前进法型多因素分析得:DP术后并发症危险因素相关性:性别术中出血病理年龄肿物粘连糖尿病手术耗时。结论:DP术后并发症危险因素相关性:性别术中出血病理年龄肿物粘连糖尿病手术耗时。
[Abstract]:Objective: to explore the risk factors of early complications after resection of body and tail of pancreas, to provide reference for clinicians and to prevent and reduce the complications after resection of body and tail of pancreas. Methods: the clinical data of 60 patients who were admitted to Union Hospital of Fujian Medical University from April 2008 to November 2014 were analyzed retrospectively. Age, sex, body mass index (BMI), prognostic nutrition index (PNI), preoperative hypertension, preoperative diabetes mellitus, preoperative hyperlipidemia, CT value of normal pancreatic tissue, postoperative pathology, time consuming, intraoperative bleeding, operative mode (open / endoscopy), 18 indexes such as splenectomy / spleen preservation, adhesion between tumor and surrounding tissues, postoperative gastric emptying delay (DGE), postoperative pancreatic fistula (POPF), postoperative abdominal infection and postoperative lung infection were studied. The risk factors of early postoperative complications (PF, peritoneal infection, pulmonary infection, postoperative DGE) were analyzed by two categories of univariate analysis. Finally, logistic multivariate regression analysis was carried out to evaluate the occurrence and risk factors of complications after DP operation. The result is 1: 1. Postoperative complications occurred in 45 of 60 cases (75.0%). Postoperative pancreatic fistula occurred in 42 cases (70.0%); abdominal infection in 19 cases (31.7%); postoperative DGE in 30 cases (50.0%); pulmonary infection in 13 cases (21.710%). Female, abdominal infection was the independent risk factor of pancreatic fistula after DP (P0.05), age 鈮，

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