胰十二指肠切除术后并发症及死亡的相关危险因素分析
发布时间：2018-09-05 20:37
【摘要】：目的本研究通过回顾性分析188例患者的病历资料,探讨与胰十二指肠切除术后严重并发症及手术死亡有关的危险因素,为降低并发症发生率及死亡率,提高手术安全性提供一定的帮助。方法回顾性分析2011年10月至2014年10月三年间山东大学齐鲁医院住院胰十二指肠切除术病例188例。其中,男108例(57.0%),女80例(43.0%)；年龄20—77岁,平均年龄57.3±10.3岁。危险因素主要选取：年龄、性别、肿瘤类型、肿瘤大小、淋巴结转移、是否有腹部手术史、手术方式、手术时间、出血量、有无其他疾病、术前血清总胆红素水平、术前血清白蛋白水平、术前血红蛋白水平、胰腺质地等指标。数据的统计处理由SPSS 19.0统计软件和Microsoft Office Excel2007工作表完成。单变量分析根据情况选用卡方检验。对P0.10的因素采用逐步Logistic回归进行多变量分析,保留在Logistic回归模型中的因素为有意义的独立危险因素。结果患者总体并发症的发生率为42.0%(79/188),死亡病例3.2%(6/188)。并发症发率从高至低依次为胰瘘20.7%(39/188)、腹腔感染13.8%(26/188)、胆瘘9.6%(18/188)、胃瘫8.5%(16/188)、刀口问题(感染、液化、裂开)8.0%(15/188)、腹腔出血5.9%(11/188)、消化道出血2.7%(5/188),肺部感染1.6%(3/188)等。患者糖尿病(OR=6.966),术前总胆红素(≥171 μol/L)(OR=8.607),术前血清白蛋白(35g/L)(OR=10.429),胰腺质地(软)(OR=4.578)是胰十二指肠切除术后胰瘘的独立危险因素,胰瘘的预测方程为：P=1/[1十e-(-5.127+1.941*糖尿病+2.153*术前总胆红囊(≥171μmol/L)+2345*术前血清白蛋白(35g/L)+1.521*胰腺质地软)]；手术出血(≥400m1)(OR=4.412),胰瘘(OR=55.773)和胆瘘(OR=29.791)是术后腹腔感染的独立危险因素,腹腔感染的预测方程为：P=1/[1十e-(-5.191+4.021*胰瘘+1.484*手术出血(≥400ml)+3394+胆漏)]；术后血清白蛋白(35g/L)(OR=5.379),胆总管直径(1.5cm)(OR=3.013)和胰瘘(OR=8.397)是术后胆瘘的独立危险因素,胆瘘的预测方程为：P=1/[1十e-(-4.693+1.682*术后血清白蛋白(35g/L)+1.103胆总管直径(1.5cm)+2.128*胰瘘)]；酗酒史(OR=3.215),糖尿病(OR=4.335)和手术方式(PPPD)(OR=7.797)是术后胃瘫的危险因素,胃瘫的预测方程为：P=1/[1十e-(-4.261+1.168*酗酒史+1467*糖尿病+2.054*手术方式(PPPD))]；腹腔出血的危险因素为手术出血(≥400m1)(OR=9.987)、吻合口瘘(OR=6.619)和术前血红蛋白(100g/L)(OR=5.860),腹腔出血的预测方程为：P=1/[1十e-(-4.852+2.301*手术出血(≥400ml)+1.890+吻合口瘘+1.768*前血红蛋白100g/L))]；年龄(≥65)(OR=19.076)、腹腔感染(OR=4.971)和腹腔出血(OR=23.561)是术后早期死亡的独立危险因素,术后早期死亡的预测方程为：P=1/[1十e-(-5.817+1.604*腹腔感染+3.16*腹腔出血+2.948*年龄(≥65))]。结论患者糖尿病、术前总胆红素(≥171 μmol/L)、术前血清白蛋白(35g/L)以及胰腺的质地(软)是胰十二指肠切除术后胰瘘的独立危险因素；手术出血(≥400m1)、胰瘘、胆瘘是术后腹腔感染的独立危险因素；术后血清白蛋白(35g/L)、胆总管直径(1.5cm)和胰瘘是术后胆瘘的独立危险因素；酗酒史、糖尿病和手术方式(PPPD)是术后胃瘫的危险因素；腹腔出血的危险因素为手术出血(≥400m1)、吻合口瘘和术前血红蛋白(100g/L)；年龄(≥65)、腹腔感染、腹腔出血是术后早期死亡的独立危险因素。因此,纠正改善术前患者身体状况,术中谨慎处理,术后加强护理,可以一定程度上减少患者并发症的发生。
[Abstract]:Objective To investigate the risk factors associated with severe complications and operative mortality after pancreatoduodenectomy by retrospective analysis of 188 cases of pancreaticoduodenectomy in order to reduce the incidence of complications and mortality and improve surgical safety. 188 cases of pancreaticoduodenectomy were hospitalized in Qilu Hospital of University. Among them, 108 cases were male (57.0%) and 80 cases were female (43.0%). The age ranged from 20 to 77 years, with an average age of 57.3 [10.3]. The risk factors were age, sex, tumor type, tumor size, lymph node metastasis, abdominal operation history, operation method, operation time, bleeding volume, and presence or absence of the risk factors. His disease, preoperative serum total bilirubin level, preoperative serum albumin level, preoperative hemoglobin level, pancreatic texture and other indicators. Statistical data processing by SPSS 19.0 statistical software and Microsoft Office Excel 2007 worksheet completed. Univariate analysis according to the situation selected chi-square test. For the factors of P 0.10 using stepwise logistic regression. Results The overall incidence of complications was 42.0% (79/188) and 3.2% (6/188). The incidence of complications was 20.7% (39/188), 13.8% (26/188), 9.6% (18/188) of biliary fistula, 8.5% (16/188) of gastroparesis, knife. Oral problems (infection, liquefaction, cleavage) 8.0% (15/188), abdominal bleeding 5.9% (11/188), gastrointestinal bleeding 2.7% (5/188), pulmonary infection 1.6% (3/188), diabetes mellitus (OR = 6.966), preoperative total bilirubin (> 171 muol / L) (OR = 8.607), preoperative serum albumin (OR = 10.429), pancreatic texture (OR = 4.578) are pancreatic fistula after pancreatoduodenectomy. The predictive equation for pancreatic fistula was: P = 1 /[1 decae - (- 5.127 + 1.941 * diabetes + 2.153 * preoperative total biliary erythrocyst (> 171 micromol / L) + 2345 * preoperative serum albumin (> 35g / L) + 1.521 * soft pancreatic texture)]; operative bleeding (> 400 m1) (OR = 4.412), pancreatic fistula (> 55.773) and biliary fistula (> OR = 29.791) were independent risk factors for postoperative abdominal infection. The predictive equations of cavity infection were: P = 1 /[1 decae - (- 5.191 + 4.021 * pancreatic fistula + 1.484 * operative bleeding (> 400 ml) + 3394 + bile leakage]; postoperative serum albumin (35 g / L) (OR = 5.379), common bile duct diameter (1.5 cm) (OR = 3.013) and pancreatic fistula (OR = 8.397) were independent risk factors for postoperative biliary fistula. The predictive equations for biliary fistula were: P = 1 /[1 decae - (- 4.693 + 1.682 *). Albumin (35g/L) + 1.103 common bile duct diameter (1.5cm) + 2.128 * pancreatic fistula]; alcoholism history (OR = 3.215), diabetes mellitus (OR = 4.335) and surgical procedure (PPPD) (OR = 7.797) were risk factors for postoperative gastroparesis. The predictive equation for gastroparesis was: P = 1 /[10 e - (- 4.261 + 1.168 * alcoholism history + 1467 * diabetes + 2.054 * surgical procedure (PPPD)]; and the risk factors for abdominal bleeding were: P = 1 /[10 e - (- 4.261 + 1.168 * alcoholism + 1467 The predictive equations of operative bleeding (> 400 m1) (OR = 9.987), anastomotic fistula (OR = 6.619) and preoperative hemoglobin (100 g / L) (OR = 5.860) were: P = 1 /[10 e - (- 4.852 + 2.301 * operative bleeding (> 400 ml) + 1.890 + anastomotic fistula + 1.768 * hemoglobin 100 g / L)]; age (> 65) (OR = 19.076), abdominal infection (OR = 4.971) and abdominal hemorrhage (OR = 23.56). 1) It is an independent risk factor for early postoperative mortality. The predictive equation of early postoperative mortality is: P = 1 /[10e - (- 5.817 + 1.604 * abdominal infection + 3.16 * abdominal hemorrhage + 2.948 * age (> 65)]. Postoperative pancreatic fistula was an independent risk factor; operative bleeding (> 400m1), pancreatic fistula and biliary fistula were independent risk factors for postoperative abdominal infection; postoperative serum albumin (35g/L), common bile duct diameter (1.5cm) and pancreatic fistula were independent risk factors for postoperative biliary fistula; alcoholism history, diabetes mellitus and surgical procedure (PPPD) were risk factors for postoperative gastroparesis; The risk factors of blood were operative bleeding (>400m1), anastomotic leakage and preoperative hemoglobin (>100g/L); age (>65), abdominal infection and abdominal hemorrhage were independent risk factors for early postoperative death. Therefore, correcting and improving preoperative patients'physical condition, careful treatment during operation and strengthening postoperative care can reduce the complications to a certain extent. Happen.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.5
本文编号：2225398
[Abstract]:Objective To investigate the risk factors associated with severe complications and operative mortality after pancreatoduodenectomy by retrospective analysis of 188 cases of pancreaticoduodenectomy in order to reduce the incidence of complications and mortality and improve surgical safety. 188 cases of pancreaticoduodenectomy were hospitalized in Qilu Hospital of University. Among them, 108 cases were male (57.0%) and 80 cases were female (43.0%). The age ranged from 20 to 77 years, with an average age of 57.3 [10.3]. The risk factors were age, sex, tumor type, tumor size, lymph node metastasis, abdominal operation history, operation method, operation time, bleeding volume, and presence or absence of the risk factors. His disease, preoperative serum total bilirubin level, preoperative serum albumin level, preoperative hemoglobin level, pancreatic texture and other indicators. Statistical data processing by SPSS 19.0 statistical software and Microsoft Office Excel 2007 worksheet completed. Univariate analysis according to the situation selected chi-square test. For the factors of P 0.10 using stepwise logistic regression. Results The overall incidence of complications was 42.0% (79/188) and 3.2% (6/188). The incidence of complications was 20.7% (39/188), 13.8% (26/188), 9.6% (18/188) of biliary fistula, 8.5% (16/188) of gastroparesis, knife. Oral problems (infection, liquefaction, cleavage) 8.0% (15/188), abdominal bleeding 5.9% (11/188), gastrointestinal bleeding 2.7% (5/188), pulmonary infection 1.6% (3/188), diabetes mellitus (OR = 6.966), preoperative total bilirubin (> 171 muol / L) (OR = 8.607), preoperative serum albumin (OR = 10.429), pancreatic texture (OR = 4.578) are pancreatic fistula after pancreatoduodenectomy. The predictive equation for pancreatic fistula was: P = 1 /[1 decae - (- 5.127 + 1.941 * diabetes + 2.153 * preoperative total biliary erythrocyst (> 171 micromol / L) + 2345 * preoperative serum albumin (> 35g / L) + 1.521 * soft pancreatic texture)]; operative bleeding (> 400 m1) (OR = 4.412), pancreatic fistula (> 55.773) and biliary fistula (> OR = 29.791) were independent risk factors for postoperative abdominal infection. The predictive equations of cavity infection were: P = 1 /[1 decae - (- 5.191 + 4.021 * pancreatic fistula + 1.484 * operative bleeding (> 400 ml) + 3394 + bile leakage]; postoperative serum albumin (35 g / L) (OR = 5.379), common bile duct diameter (1.5 cm) (OR = 3.013) and pancreatic fistula (OR = 8.397) were independent risk factors for postoperative biliary fistula. The predictive equations for biliary fistula were: P = 1 /[1 decae - (- 4.693 + 1.682 *). Albumin (35g/L) + 1.103 common bile duct diameter (1.5cm) + 2.128 * pancreatic fistula]; alcoholism history (OR = 3.215), diabetes mellitus (OR = 4.335) and surgical procedure (PPPD) (OR = 7.797) were risk factors for postoperative gastroparesis. The predictive equation for gastroparesis was: P = 1 /[10 e - (- 4.261 + 1.168 * alcoholism history + 1467 * diabetes + 2.054 * surgical procedure (PPPD)]; and the risk factors for abdominal bleeding were: P = 1 /[10 e - (- 4.261 + 1.168 * alcoholism + 1467 The predictive equations of operative bleeding (> 400 m1) (OR = 9.987), anastomotic fistula (OR = 6.619) and preoperative hemoglobin (100 g / L) (OR = 5.860) were: P = 1 /[10 e - (- 4.852 + 2.301 * operative bleeding (> 400 ml) + 1.890 + anastomotic fistula + 1.768 * hemoglobin 100 g / L)]; age (> 65) (OR = 19.076), abdominal infection (OR = 4.971) and abdominal hemorrhage (OR = 23.56). 1) It is an independent risk factor for early postoperative mortality. The predictive equation of early postoperative mortality is: P = 1 /[10e - (- 5.817 + 1.604 * abdominal infection + 3.16 * abdominal hemorrhage + 2.948 * age (> 65)]. Postoperative pancreatic fistula was an independent risk factor; operative bleeding (> 400m1), pancreatic fistula and biliary fistula were independent risk factors for postoperative abdominal infection; postoperative serum albumin (35g/L), common bile duct diameter (1.5cm) and pancreatic fistula were independent risk factors for postoperative biliary fistula; alcoholism history, diabetes mellitus and surgical procedure (PPPD) were risk factors for postoperative gastroparesis; The risk factors of blood were operative bleeding (>400m1), anastomotic leakage and preoperative hemoglobin (>100g/L); age (>65), abdominal infection and abdominal hemorrhage were independent risk factors for early postoperative death. Therefore, correcting and improving preoperative patients'physical condition, careful treatment during operation and strengthening postoperative care can reduce the complications to a certain extent. Happen.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.5
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