本文選題：POSSUM + P-POSSUM�。� 參考：《河北醫(yī)科大學》2015年碩士論文

【摘要】：目的:通過回顧性研究分析胰十二指腸切除術后并發(fā)癥及死亡的相關危險因素,探討POSSUM及其改良的評分系統(tǒng)在預測胰十二指腸切除術手術風險中的臨床應用價值。方法:收集2010年1月至2013年12月在河北醫(yī)科大學第四醫(yī)院肝膽外科行胰十二指腸切除術的病例350例,統(tǒng)計這些病例術前營養(yǎng)狀況、全身的生理狀態(tài)、重要臟器功能、圍手術期準備、手術情況、胰腺條件、腫瘤的大小及部位、術后生長抑素的應用、POSSUM評分等指標,分析其與術后并發(fā)癥及死亡的相關性。采用Logistic回歸分析篩選出與術后并發(fā)癥及死亡的相關危險因素。對350例病例資料進行POSSUM評分,通過評分計算出預測的并發(fā)癥發(fā)生率及死亡率,與實際的并發(fā)癥發(fā)生率及死亡率進行比較,觀察預測值與實際值的契合程度。所有數(shù)據(jù)采用SPSS 21.0統(tǒng)計軟件進行分析處理,單因素分析采用χ2檢驗,多因素分析采用Logistic回歸分析。P0.05為差異有統(tǒng)計學意義。結果:本組350例胰十二指腸切除術患者術后發(fā)生并發(fā)癥160例(45.71%)。其中死亡11例(3.14%),胰瘺47例(13.43%),出血37例(10.57%),胃排空延遲31例(8.86%),應激性潰瘍22例(6.28%)、腹腔感染50例(14.28%),胸腔積液8例(2.28%)、腹腔積液5例(1.42%),肺炎11例(3.14%),膽瘺6例(1.71%)。經(jīng)Logistic回歸分析顯示:年齡、體重、呼吸系統(tǒng)疾病、腫瘤體積、腫瘤部位、術后是否應用生長抑素是影響并發(fā)癥發(fā)生的危險因素(P0.05)。350例行胰十二指腸切除術患者的生理學指標評分是12~34分,平均分值為18.53±4.28,手術嚴重性指標評分是14~24分,平均分值為16.33±1.89,總的POSSUM評分是26~58分,平均分值為34.85±4.82。POSSUM評分系統(tǒng)預測的并發(fā)癥發(fā)生率是53.88%,實際的并發(fā)癥發(fā)生率是45.71%,二者相比較,經(jīng)χ2檢驗,P0.05,結果有統(tǒng)計學差異,POSSUM評分系統(tǒng)過高預測了患者術后的并發(fā)癥發(fā)生率。POSSUM評分系統(tǒng)預測的死亡率是11.72%,實際的死亡率是3.14%,經(jīng)χ2檢驗,P0.01,結果有統(tǒng)計學差異,也過高預測了患者術后的死亡率,P-POSSUM評分系統(tǒng)(用于預測死亡率的改良POSSUM評分系統(tǒng))預測的死亡率是3.23%,經(jīng)χ2檢驗,P0.05,結果無統(tǒng)計學差異,能比較準確地預測患者術后死亡率。結論:患者的年齡、體重、呼吸系統(tǒng)疾病、腫瘤體積、腫瘤部位、術后是否應用生長抑素是影響胰十二指腸切除術后并發(fā)癥及死亡的相關危險因素。POSSUM評分系統(tǒng)預測胰十二指腸切除術患者的術后并發(fā)癥發(fā)生率及死亡率均偏高,而改良的P-POSSUM評分系統(tǒng)能較好的預測患者術后死亡率,但不能很好的預測并發(fā)癥發(fā)生率。POSSUM評分系統(tǒng)預測胰十二指腸切除術手術風險有一定的臨床應用價值,但仍需進一步研究完善。
[Abstract]:Objective: to analyze the risk factors of complications and death after pancreaticoduodenectomy and to explore the clinical application value of POSSUM and its improved scoring system in predicting the risk of pancreatoduodenectomy. Methods: from January 2010 to December 2013, 350 cases of pancreaticoduodenectomy in the Department of Hepatobiliary surgery of the fourth Hospital of Hebei Medical University were collected. Perioperative preparation, surgical condition, pancreatic condition, tumor size and location, postoperative somatostatin application and possum score were analyzed to analyze the correlation with postoperative complications and death. Logistic regression analysis was used to screen the risk factors associated with postoperative complications and death. The incidence and mortality of complications were calculated and compared with the actual incidence of complications and mortality, and the degree of agreement between the predicted value and the actual value was observed. All data were analyzed by SPSS 21.0 software, 蠂 2 test was used for univariate analysis and Logistic regression analysis was used for multivariate analysis. Results: there were 160 cases of complications after pancreaticoduodenectomy in this group. Among them, 11 cases died, 47 cases had pancreatic fistula, 37 cases had hemorrhage, 37 cases had gastric emptying, 31 cases had delayed gastric emptying, 22 cases had stress ulcer, 22 cases had stress ulcer, 50 cases had intraperitoneal infection with 14. 28T, 8 cases had pleural effusion, 5 cases had abdominal effusion, 11 cases had pneumonia and 3.14%, 6 cases had bile fistula. Logistic regression analysis showed that age, body weight, respiratory diseases, tumor volume, tumor location, Postoperatively, somatostatin was a risk factor for complications. The physiological index scores of patients undergoing pancreaticoduodenectomy were 12 ~ 34 points, the average score was 18.53 鹵4.28, and the operative severity score was 14 ~ 24 points. The average score was 16.33 鹵1.89, the total POSSUM score was 26 ~ 58 points, the average score was 34.85 鹵4.82.POSSUM scoring system, the predicted complication rate was 53.88 and the actual complication rate was 45.71. By 蠂 2 test, P 0.05, the results were statistically different. The incidence of postoperative complications was predicted by the possum scoring system. The mortality rate predicted by the possum scoring system was 11.72, and the actual mortality was 3.14. After 蠂 2 test, P 0.01, the results were statistically different. The mortality rate predicted by P-POSSUM scoring system (an improved POSSUM scoring system for predicting mortality) was 3.23%. 蠂 ~ 2 test showed that there was no statistical difference between the two groups and the postoperative mortality rate could be predicted more accurately. Conclusion: age, body weight, respiratory diseases, tumor volume, tumor location, Postoperatively, somatostatin was a risk factor for postoperative complications and death after pancreaticoduodenectomy. Possum scoring system was used to predict the incidence and mortality of postoperative complications in patients with pancreatoduodenectomy. The modified P-POSSUM scoring system can predict the postoperative mortality, but it can not predict the incidence of complications. Possum scoring system can predict the risk of pancreaticoduodenectomy. But it still needs further research and perfection.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R656

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