本文選題：胰十二指腸切除術(shù) + 并發(fā)癥　； 參考：《山西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:通過對經(jīng)PD患者的病歷進(jìn)行回顧性研究,探討與胰十二指腸切除術(shù)后早期主要的并發(fā)癥及死亡有關(guān)的危險因素,為降低并發(fā)癥發(fā)生率、病死率和臨床工作提供幫助。方法:回顧性分析山大二院、三院于2009.6-2014.6,根據(jù)排除標(biāo)準(zhǔn)納入研究對象的129例行胰十二指腸切除術(shù)(PD)患者的臨床資料。129例患者中,其中女性49例(38.0%),男性80例(62.0%),年齡22~79歲,平均年齡56.1歲。將性別、年齡(=65歲)、術(shù)前是否合并其他并發(fā)癥(主要指高血壓、糖尿病、心臟疾病)、術(shù)前白蛋白水平(=35g/L)、術(shù)前血總膽紅素水平(=171umol/L)、術(shù)前黃疸持續(xù)時間(=30天)、手術(shù)時間(=6h)、術(shù)中失血量(=1000ml)、胰腺質(zhì)地、胰腸吻合方式、是否留置胰管支撐管、主胰管直徑(=3mm)、腫瘤部位、腫瘤大小、腫瘤性質(zhì)15項指標(biāo)作為研究對象。設(shè)計表格將可能影響術(shù)后早期并發(fā)癥(胰瘺、膽瘺、出血、感染(主要包括肺部感染、腹腔感染)、胃排空障礙、多器官功能障礙綜合征、切口感染)的危險因素進(jìn)行兩分類單因素分析,再將各單因素進(jìn)行Logistic多因素回歸分析(P0.05)。評價PD術(shù)后早期并發(fā)癥的發(fā)生情況及其相關(guān)危險因素。結(jié)果:本組129例PD術(shù)患者中,術(shù)后1個月內(nèi)出現(xiàn)主要并發(fā)癥者有58例(45.0%),其中胰瘺32例(24.8%)、感染31例(24.0%)、出血13例(10.1%)、膽瘺12例(9.3%)、切口感染11例(8.5%)、胃排空功能障礙10例(7.8%)、MODS3例(2.3%)、死亡6例(4.7%)。統(tǒng)計學(xué)分析表明,單因素分析后術(shù)前總膽紅素、術(shù)中出血量及腫瘤性質(zhì)與術(shù)后早期并發(fā)癥的發(fā)生呈相關(guān)性(P0.05,且OR1);將所選15個獨立危險因素通過logistic前進(jìn)法進(jìn)行多變量分析得:術(shù)中出血量、主胰管直徑和腫瘤性質(zhì)是影響胰十二指腸切除術(shù)后早期主要并發(fā)癥發(fā)生率的獨立危險因素;術(shù)中出血量是膽瘺和出血發(fā)生的獨立危險因素;術(shù)前黃疸持續(xù)時間、術(shù)中出血量及主胰管直徑是胰瘺發(fā)生的獨立危險因素;術(shù)前總膽紅素水平是感染發(fā)生的獨立危險因素(所有P0.05)。結(jié)論:胰十二指腸切除術(shù)仍是一項的高風(fēng)險的手術(shù),術(shù)后早期并發(fā)癥的發(fā)病率仍較高,病死率有所降低,死亡的主要原因是各種并發(fā)癥誘發(fā)的多器官功能障礙綜合征及腹腔感染、出血。術(shù)中出血量達(dá)到1000ml以上、主胰管直徑較小以及惡性腫瘤患者的PD術(shù)后并發(fā)癥發(fā)生率和病死率更高。術(shù)中出血量超過1000ml可增加PD術(shù)后膽瘺及出血發(fā)生的風(fēng)險。術(shù)前黃疸持續(xù)時間、術(shù)中出血量及主胰管直徑是PD術(shù)后胰瘺發(fā)生的獨立危險因素。術(shù)前總膽紅素水平的高低影響了PD術(shù)后感染并發(fā)癥的發(fā)生率。年齡并未影響PD術(shù)后各并發(fā)癥的發(fā)生率。
[Abstract]:Objective: to investigate the risk factors related to the early complications and death after pancreaticoduodenectomy through a retrospective study of the medical records of patients with PD, in order to reduce the incidence of complications, mortality and clinical work.Methods: retrospective analysis was made on the clinical data of 129 patients with PDD who underwent pancreaticoduodenectomy according to the exclusion criteria. Among them, 49 were female (38.0%) and 80 were male (62.0). The age was 22 ~ 79 years old.The average age is 56.1 years.Sex, age, age of 65 years, preoperative complications (mainly hypertension, diabetes,Heart disease, preoperative albumin level is up to 35g / L, preoperative total bilirubin level is 171umoll / L, preoperative jaundice duration is 30 days, operation time is up to 6hs, intraoperative blood loss is less than 1000ml / L, pancreas texture, pancreaticojejunostomy mode, whether pancreatic duct support tube is retained.The diameter of the main pancreatic duct was 3 mm, tumor location, tumor size and tumor nature were studied.The design form may affect early postoperative complications (pancreatic fistula, biliary fistula, bleeding, infection (mainly pulmonary infection, abdominal infection, gastric emptying disorder, multiple organ dysfunction syndrome).The risk factors of incisional infection were analyzed by two classification single factor analysis, and the Logistic multivariate regression analysis was performed on each single factor (P 0.05).To evaluate the incidence and risk factors of early postoperative complications after PD.Results: of the 129 PD patients, 58 had major complications within one month, including 32 cases with pancreatic fistula, 24. 8%, 31 cases with pancreatic fistula, 24. 0%, 13 cases with hemorrhage, 12 cases with bile fistula, 11 cases with incision infection, 11 cases with incision infection, 10 cases with gastric emptying dysfunction and 3 cases with MODS, and 6 cases died.Statistical analysis showed that the total bilirubin before operation after univariate analysis,There was a correlation between the intraoperative bleeding volume and tumor nature and the occurrence of early postoperative complications (P 0.05 and OR1). The results of multivariate analysis of 15 independent risk factors by logistic were as follows: intraoperative bleeding volume;The diameter of the main pancreatic duct and the nature of the tumor were independent risk factors affecting the incidence of major complications after pancreaticoduodenectomy, the amount of intraoperative bleeding was an independent risk factor for biliary fistula and hemorrhage, and the duration of preoperative jaundice,Intraoperative bleeding and diameter of the main pancreatic duct were independent risk factors for pancreatic fistula, and preoperative total bilirubin level was an independent risk factor for infection (all P 0.05).Conclusion: pancreaticoduodenectomy is still a high-risk operation, the incidence of early postoperative complications is still high, and the mortality is lower.The main causes of death are multiple organ dysfunction syndrome, abdominal infection and hemorrhage induced by various complications.The incidence and mortality of postoperative complications in patients with malignant tumor were higher than that of 1000ml, the diameter of the main pancreatic duct was small and the incidence of postoperative complications was higher in patients with malignant tumor.Intraoperative bleeding over 1000ml increased the risk of biliary fistula and bleeding after PD.Preoperative jaundice duration, intraoperative bleeding volume and main pancreatic duct diameter were independent risk factors for pancreatic fistula after PD.The preoperative level of total bilirubin affected the incidence of postoperative infection complications.Age did not affect the incidence of complications after PD.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R656.6

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相關(guān)期刊論文 前2條

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本文編號：1769651