本文選題：梗阻性黃疸 + 胰十二指腸切除術(shù)　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:了解術(shù)前黃疸水平對(duì)胰十二指腸切除術(shù)的影響,探究術(shù)后并發(fā)癥的相關(guān)危險(xiǎn)因素。并探討"可切除胰腺癌患者合并梗阻性黃疸"是否常規(guī)術(shù)前減黃的臨床決策。方法:對(duì)浙江大學(xué)附屬邵逸夫醫(yī)院2010年1月至2016年10月74例術(shù)前有黃疸,并行胰十二指腸切除術(shù)的病例資料進(jìn)行回顧性分析。其中,男48例,女26例,男女比例為1.846:1。年齡43-80歲(平均62.97±8.67歲)。術(shù)前黃疸水平36.7-719.3μmol/L(平均244.40±162.76μmol/L)。胰頭癌74例,胰體尾癌0例。均行胰十二脂腸切除術(shù)(腹腔鏡22例,開腹52例)。術(shù)前進(jìn)行減黃操作6例(均為PTCD),未減黃68例。根據(jù)術(shù)前黃疸水平,將病人分為輕度黃膽組(171μmol/L)、中度黃膽組(171-342μmol/L)及重度黃膽組(342μmol/L),比較三個(gè)組的一般資料、圍手術(shù)期指標(biāo)、術(shù)后并發(fā)癥、死亡率以及預(yù)后,了解術(shù)前黃疸水平對(duì)胰十二指腸切除術(shù)的影響。同時(shí),分析術(shù)后并發(fā)癥發(fā)生的相關(guān)危險(xiǎn)因素,并比較術(shù)前減黃組與未減黃組的基本指標(biāo)有無統(tǒng)計(jì)學(xué)差異。采用SPSS 22.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,統(tǒng)計(jì)中P值小于0.05被認(rèn)為具有統(tǒng)計(jì)學(xué)意義。結(jié)果:不同黃疸水平在術(shù)中出血量上有顯著性差異(P=0.008),中度黃疸組出血量顯著多于輕度黃疸組和重度黃疸組。在性別、年齡、BMI、手術(shù)時(shí)間、TNM分期、住院時(shí)間、術(shù)后住院時(shí)間、住院費(fèi)用上三組均無顯著性差異(P0.05)。輕度、中度、重度黃疸組術(shù)后并發(fā)癥及死亡率均無顯著性差異(P0.05)。二元Logistic回歸分析發(fā)現(xiàn)年齡≥65 歲(OR=16.002,95%CI:1.682-152.264,P=0.016)、男性(OR=10.036,95%CI:1.920-52.464,P=0.006)是術(shù)后并發(fā)癥發(fā)生的兩個(gè)獨(dú)立危險(xiǎn)因素。術(shù)后并發(fā)癥與術(shù)前總膽紅素水平及術(shù)前直接膽紅素水平并沒有相關(guān)性(P0.05)。輕度黃疸組中位生存時(shí)間為8.9月,中度黃疸組中位生存時(shí)間為12.9月,重度黃疸組中位生存時(shí)間為12.1月,三者不具有統(tǒng)計(jì)學(xué)差異(P=0.678)。術(shù)前減黃組與未減黃組在BMI、手術(shù)時(shí)間、術(shù)中出血量、住院時(shí)間、術(shù)后住院時(shí)間、住院費(fèi)用、術(shù)后并發(fā)癥及死亡率上均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:術(shù)前黃疸水平對(duì)胰十二指腸切除術(shù)的影響不大,術(shù)前減黃價(jià)值有限,應(yīng)根據(jù)病人的全身狀況、治療方案,以及是否有黃疸相關(guān)癥狀等選擇性進(jìn)行。
[Abstract]:Objective: to investigate the influence of preoperative jaundice on pancreaticoduodenectomy and explore the risk factors of postoperative complications. To explore the clinical decision of "resectable pancreatic cancer patients with obstructive jaundice" before operation. Methods: the data of 74 patients with jaundice and pancreaticoduodenectomy from January 2010 to October 2016 in run Shaw Hospital affiliated to Zhejiang University were analyzed retrospectively. Of these, 48 were males and 26 were females, with a ratio of 1.846: 1. The age ranged from 43 to 80 years (mean 62.97 鹵8.67 years). Preoperative jaundice levels were 36.7-719.3 渭 mol / L (mean 244.40 鹵162.76 渭 mol / L). There were 74 cases of pancreatic head carcinoma and 0 cases of pancreatic body and tail carcinoma. All patients underwent cholecystectomy (22 cases by laparoscopy and 52 cases by laparotomy). Preoperative yellow reduction operation was performed in 6 cases (all PTCDD, 68 cases without yellow reduction. According to the preoperative jaundice level, the patients were divided into mild yellow bile group (171 渭 mol / L / L), moderate yellow bile group (171-342 渭 mol / L) and severe yellow bile group (342 渭 mol / L). The general data, perioperative parameters, postoperative complications, mortality and prognosis were compared among the three groups. To investigate the effect of preoperative jaundice on pancreaticoduodenectomy. At the same time, the risk factors of postoperative complications were analyzed. The statistical data were analyzed by SPSS 22. 0 statistical software. The P value less than 0. 05 was considered to be statistically significant. Results: there was significant difference in the amount of intraoperative bleeding among different jaundice levels. The amount of bleeding in moderate jaundice group was significantly higher than that in mild jaundice group and severe jaundice group. There was no significant difference in sex, age, TNM stage, hospitalization time, postoperative hospitalization time and hospitalization cost among the three groups (P 0.05). There was no significant difference in postoperative complications and mortality among mild, moderate and severe jaundice groups (P 0.05). The binary Logistic regression analysis showed that the two independent risk factors of postoperative complications were the age 鈮，

本文編號(hào)：1981339