【摘要】：目的:探討胰體尾切除術(shù)后早期并發(fā)癥的相關(guān)危險因素,為臨床醫(yī)師提供借鑒,預(yù)防和減少胰體尾切除術(shù)后并發(fā)癥的發(fā)生。方法:回顧性分析2008年4月至2014年11月入住福建醫(yī)科大學(xué)附屬協(xié)和醫(yī)院,根據(jù)排除標準納入研究對象的60例胰體尾切除術(shù)(DP)患者的臨床資料。將年齡、性別、體重指數(shù)(BMI)、預(yù)后營養(yǎng)指數(shù)(PNI)、術(shù)前高血壓、術(shù)前糖尿病、術(shù)前高脂血癥、正常胰腺組織CT值、術(shù)后病理、手術(shù)耗時、術(shù)中出血、手術(shù)方式(開放/腔鏡、切脾/保脾)、腫物與周圍組織粘連情況、術(shù)后胃排空延遲(DGE)、術(shù)后胰瘺(POPF)、術(shù)后腹腔感染、術(shù)后肺部感染等18項指標作為研究對象。設(shè)計表格,將可能影響術(shù)后早期并發(fā)癥(PF、腹腔感染、肺部感染、術(shù)后DGE)的危險因素進行兩分類單因素分析。最后將各單因素分析中有意義項進行Logistic多因素回歸分析,評價DP術(shù)后并發(fā)癥的發(fā)生情況及其危險因素。結(jié)果:1.本組60例病例中45出現(xiàn)術(shù)后并發(fā)癥,發(fā)生率為75.0%。其中術(shù)后胰瘺42例,發(fā)生率70.0%;腹腔感染19例,發(fā)生率31.7%;術(shù)后DGE 30例,發(fā)生率50.0%;肺部感染13例,發(fā)生率21.7%;1例死于術(shù)后嚴重腹腔感染、肝功能衰竭,死亡率1.7%。2.女性、腹腔感染為影響DP術(shù)后胰瘺的獨立危險因素(P0.05);年齡≥60歲、腹腔感染為影響DP術(shù)后CR-PF的獨立危險因素(P0.05);年齡≥60歲、糖尿病、腫物與周圍組織粘連明顯、術(shù)后DGE、術(shù)后發(fā)生PF及CR-PF為影響DP術(shù)后腹腔感染的獨立危險因素(P0.05);年齡≥60歲、惡性腫瘤、腫物與周圍組織粘連明顯、術(shù)后發(fā)生腹腔感染是影響DP術(shù)后DGE的獨立危險因素(P0.05);手術(shù)時間≥4h、術(shù)中出血≥300ml、術(shù)后發(fā)生胰瘺、腹腔感染為影響DP術(shù)后肺部感染的獨立危險因素(P0.05)。上述7個獨立危險因素通過Logistic前進法型多因素分析得:DP術(shù)后并發(fā)癥危險因素相關(guān)性:性別術(shù)中出血病理年齡腫物粘連糖尿病手術(shù)耗時。結(jié)論:DP術(shù)后并發(fā)癥危險因素相關(guān)性:性別術(shù)中出血病理年齡腫物粘連糖尿病手術(shù)耗時。
[Abstract]:Objective: to explore the risk factors of early complications after resection of body and tail of pancreas, to provide reference for clinicians and to prevent and reduce the complications after resection of body and tail of pancreas. Methods: the clinical data of 60 patients who were admitted to Union Hospital of Fujian Medical University from April 2008 to November 2014 were analyzed retrospectively. Age, sex, body mass index (BMI), prognostic nutrition index (PNI), preoperative hypertension, preoperative diabetes mellitus, preoperative hyperlipidemia, CT value of normal pancreatic tissue, postoperative pathology, time consuming, intraoperative bleeding, operative mode (open / endoscopy), 18 indexes such as splenectomy / spleen preservation, adhesion between tumor and surrounding tissues, postoperative gastric emptying delay (DGE), postoperative pancreatic fistula (POPF), postoperative abdominal infection and postoperative lung infection were studied. The risk factors of early postoperative complications (PF, peritoneal infection, pulmonary infection, postoperative DGE) were analyzed by two categories of univariate analysis. Finally, logistic multivariate regression analysis was carried out to evaluate the occurrence and risk factors of complications after DP operation. The result is 1: 1. Postoperative complications occurred in 45 of 60 cases (75.0%). Postoperative pancreatic fistula occurred in 42 cases (70.0%); abdominal infection in 19 cases (31.7%); postoperative DGE in 30 cases (50.0%); pulmonary infection in 13 cases (21.710%). Female, abdominal infection was the independent risk factor of pancreatic fistula after DP (P0.05), age 鈮，

本文編號：2122842