十二指肠乳头癌行胰十二指肠切除术后并发症的相关危险因素分析

发布时间：2018-12-28 09:37

【摘要】：目的通过收集整理我院确诊十二指肠乳头癌且行十二指肠切除术治疗的85例患者的临床及病理资料,分析十二指肠乳头癌术后并发症的危险因素,并探讨消化道重建时附加布朗吻合与术后并发症相关性。为行胰十二指肠切除术治疗十二指肠乳头癌患者术后并发症的防治提供理论依据及临床参考资料。方法收集广西医科大学一附院2013年1月到2017年1月期间行胰十二指肠切除术治疗的85例十二指肠乳头癌患者的临床病例资料。均经胃镜及病理学确诊后行标准胰十二指肠切除术,所有患者行Child式重建,以年龄、性别、手术时间、出血量、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、是否行布朗吻合、胰腺质地等为观察因素,以术后胰瘘、出血、感染为因变量。对临床资料进行单因素统计分析,对于有统计意义的变量再引入二分类非条件逐步Logistic回归模型进行多因素分析,确定独立的危险因素。结果1.85例十二指肠乳头癌患者行胰十二指肠切除术后1个月内出现并发症者有30例(35.3%),分布为胰瘘9例,出血10例,感染11例,分别占10.6%、11.8%、12.9%。2.经统计学单因素分析得到:性别(男)、术前低血红蛋白(90g/L)、胰腺质地正常、无布朗吻合是胰瘘发生的危险因素;年龄≥70岁、术前高胆红素≥171umol/L、术后胰瘘、术后腹腔感染为术后出血的危险因素;年龄≥70岁、糖尿病、术前白蛋白30g/L、术前低血红蛋白(90g/L)、术前术后输血、留置胃管时间5天、术中出血量≥800ml是术后感染的危险因素。经统计学Logistic多变量分析得到:胰腺质地正常、无布朗吻合是胰瘘发生的独立危险因素;术前高胆红素、术后胰瘘、腹腔感染是术后出血的独立危险因素;糖尿病是术后感染的独立危险因素(所有P0.05)。结论胰腺质软的患者更容易发生胰瘘,布朗吻合可有效减少胰瘘的发生率。术后出血在存在术前高胆红素、术后胰瘘和术后腹腔感染的患者中更易出现,术后感染在合并糖尿病患者中更容易出现。
[Abstract]:Objective to analyze the risk factors of postoperative complications of duodenal papillary carcinoma by collecting clinical and pathological data of 85 patients with duodenal papillary carcinoma diagnosed and treated by duodenectomy in our hospital. To explore the correlation between postoperative complications and additional Brownian anastomosis during digestive tract reconstruction. To provide theoretical basis and clinical reference for the prevention and treatment of postoperative complications in patients with carcinoma of duodenal papilla by pancreaticoduodenectomy. Methods the clinical data of 85 patients with duodenal papillary carcinoma treated by pancreaticoduodenectomy from January 2013 to January 2017 in the affiliated Hospital of Guangxi Medical University were collected. All patients underwent standard pancreatoduodenectomy after gastroscopy and pathology. All patients underwent Child reconstruction with age, sex, operation time, blood loss, preoperative serum total bilirubin level and preoperative serum albumin level. Preoperative hemoglobin level, brown anastomosis and pancreas texture were observed. Postoperative pancreatic fistula, hemorrhage and infection were dependent variables. Univariate statistical analysis of clinical data and multivariate analysis of two unconditioned stepwise Logistic regression models for statistical variables were carried out to determine independent risk factors. Results 1.There were 30 cases (35.3%) with complications within one month after pancreatoduodenectomy in 85 patients with duodenal papillary carcinoma, 9 cases were pancreatic fistula, 10 cases were hemorrhage, 11 cases were infection, accounting for 10.6% (11.8%), respectively. 12.90.2. Single factor analysis showed that sex (male), preoperative low hemoglobin (90g/L), normal pancreas texture and no Brownian anastomosis were risk factors for pancreatic fistula. Age 鈮，

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