發(fā)布時(shí)間：2018-09-05 20:37

【摘要】：目的本研究通過(guò)回顧性分析188例患者的病歷資料,探討與胰十二指腸切除術(shù)后嚴(yán)重并發(fā)癥及手術(shù)死亡有關(guān)的危險(xiǎn)因素,為降低并發(fā)癥發(fā)生率及死亡率,提高手術(shù)安全性提供一定的幫助。方法回顧性分析2011年10月至2014年10月三年間山東大學(xué)齊魯醫(yī)院住院胰十二指腸切除術(shù)病例188例。其中,男108例(57.0%),女80例(43.0%)；年齡20—77歲,平均年齡57.3±10.3歲。危險(xiǎn)因素主要選�。耗挲g、性別、腫瘤類型、腫瘤大小、淋巴結(jié)轉(zhuǎn)移、是否有腹部手術(shù)史、手術(shù)方式、手術(shù)時(shí)間、出血量、有無(wú)其他疾病、術(shù)前血清總膽紅素水平、術(shù)前血清白蛋白水平、術(shù)前血紅蛋白水平、胰腺質(zhì)地等指標(biāo)。數(shù)據(jù)的統(tǒng)計(jì)處理由SPSS 19.0統(tǒng)計(jì)軟件和Microsoft Office Excel2007工作表完成。單變量分析根據(jù)情況選用卡方檢驗(yàn)。對(duì)P0.10的因素采用逐步Logistic回歸進(jìn)行多變量分析,保留在Logistic回歸模型中的因素為有意義的獨(dú)立危險(xiǎn)因素。結(jié)果患者總體并發(fā)癥的發(fā)生率為42.0%(79/188),死亡病例3.2%(6/188)。并發(fā)癥發(fā)率從高至低依次為胰瘺20.7%(39/188)、腹腔感染13.8%(26/188)、膽瘺9.6%(18/188)、胃癱8.5%(16/188)、刀口問(wèn)題(感染、液化、裂開)8.0%(15/188)、腹腔出血5.9%(11/188)、消化道出血2.7%(5/188),肺部感染1.6%(3/188)等�；颊咛悄虿�(OR=6.966),術(shù)前總膽紅素(≥171 μol/L)(OR=8.607),術(shù)前血清白蛋白(35g/L)(OR=10.429),胰腺質(zhì)地(軟)(OR=4.578)是胰十二指腸切除術(shù)后胰瘺的獨(dú)立危險(xiǎn)因素,胰瘺的預(yù)測(cè)方程為：P=1/[1十e-(-5.127+1.941*糖尿病+2.153*術(shù)前總膽紅囊(≥171μmol/L)+2345*術(shù)前血清白蛋白(35g/L)+1.521*胰腺質(zhì)地軟)]；手術(shù)出血(≥400m1)(OR=4.412),胰瘺(OR=55.773)和膽瘺(OR=29.791)是術(shù)后腹腔感染的獨(dú)立危險(xiǎn)因素,腹腔感染的預(yù)測(cè)方程為：P=1/[1十e-(-5.191+4.021*胰瘺+1.484*手術(shù)出血(≥400ml)+3394+膽漏)]；術(shù)后血清白蛋白(35g/L)(OR=5.379),膽總管直徑(1.5cm)(OR=3.013)和胰瘺(OR=8.397)是術(shù)后膽瘺的獨(dú)立危險(xiǎn)因素,膽瘺的預(yù)測(cè)方程為：P=1/[1十e-(-4.693+1.682*術(shù)后血清白蛋白(35g/L)+1.103膽總管直徑(1.5cm)+2.128*胰瘺)]；酗酒史(OR=3.215),糖尿病(OR=4.335)和手術(shù)方式(PPPD)(OR=7.797)是術(shù)后胃癱的危險(xiǎn)因素,胃癱的預(yù)測(cè)方程為：P=1/[1十e-(-4.261+1.168*酗酒史+1467*糖尿病+2.054*手術(shù)方式(PPPD))]；腹腔出血的危險(xiǎn)因素為手術(shù)出血(≥400m1)(OR=9.987)、吻合口瘺(OR=6.619)和術(shù)前血紅蛋白(100g/L)(OR=5.860),腹腔出血的預(yù)測(cè)方程為：P=1/[1十e-(-4.852+2.301*手術(shù)出血(≥400ml)+1.890+吻合口瘺+1.768*前血紅蛋白100g/L))]；年齡(≥65)(OR=19.076)、腹腔感染(OR=4.971)和腹腔出血(OR=23.561)是術(shù)后早期死亡的獨(dú)立危險(xiǎn)因素,術(shù)后早期死亡的預(yù)測(cè)方程為：P=1/[1十e-(-5.817+1.604*腹腔感染+3.16*腹腔出血+2.948*年齡(≥65))]。結(jié)論患者糖尿病、術(shù)前總膽紅素(≥171 μmol/L)、術(shù)前血清白蛋白(35g/L)以及胰腺的質(zhì)地(軟)是胰十二指腸切除術(shù)后胰瘺的獨(dú)立危險(xiǎn)因素；手術(shù)出血(≥400m1)、胰瘺、膽瘺是術(shù)后腹腔感染的獨(dú)立危險(xiǎn)因素；術(shù)后血清白蛋白(35g/L)、膽總管直徑(1.5cm)和胰瘺是術(shù)后膽瘺的獨(dú)立危險(xiǎn)因素；酗酒史、糖尿病和手術(shù)方式(PPPD)是術(shù)后胃癱的危險(xiǎn)因素；腹腔出血的危險(xiǎn)因素為手術(shù)出血(≥400m1)、吻合口瘺和術(shù)前血紅蛋白(100g/L)；年齡(≥65)、腹腔感染、腹腔出血是術(shù)后早期死亡的獨(dú)立危險(xiǎn)因素。因此,糾正改善術(shù)前患者身體狀況,術(shù)中謹(jǐn)慎處理,術(shù)后加強(qiáng)護(hù)理,可以一定程度上減少患者并發(fā)癥的發(fā)生。
[Abstract]:Objective To investigate the risk factors associated with severe complications and operative mortality after pancreatoduodenectomy by retrospective analysis of 188 cases of pancreaticoduodenectomy in order to reduce the incidence of complications and mortality and improve surgical safety. 188 cases of pancreaticoduodenectomy were hospitalized in Qilu Hospital of University. Among them, 108 cases were male (57.0%) and 80 cases were female (43.0%). The age ranged from 20 to 77 years, with an average age of 57.3 [10.3]. The risk factors were age, sex, tumor type, tumor size, lymph node metastasis, abdominal operation history, operation method, operation time, bleeding volume, and presence or absence of the risk factors. His disease, preoperative serum total bilirubin level, preoperative serum albumin level, preoperative hemoglobin level, pancreatic texture and other indicators. Statistical data processing by SPSS 19.0 statistical software and Microsoft Office Excel 2007 worksheet completed. Univariate analysis according to the situation selected chi-square test. For the factors of P 0.10 using stepwise logistic regression. Results The overall incidence of complications was 42.0% (79/188) and 3.2% (6/188). The incidence of complications was 20.7% (39/188), 13.8% (26/188), 9.6% (18/188) of biliary fistula, 8.5% (16/188) of gastroparesis, knife. Oral problems (infection, liquefaction, cleavage) 8.0% (15/188), abdominal bleeding 5.9% (11/188), gastrointestinal bleeding 2.7% (5/188), pulmonary infection 1.6% (3/188), diabetes mellitus (OR = 6.966), preoperative total bilirubin (> 171 muol / L) (OR = 8.607), preoperative serum albumin (OR = 10.429), pancreatic texture (OR = 4.578) are pancreatic fistula after pancreatoduodenectomy. The predictive equation for pancreatic fistula was: P = 1 /[1 decae - (- 5.127 + 1.941 * diabetes + 2.153 * preoperative total biliary erythrocyst (> 171 micromol / L) + 2345 * preoperative serum albumin (> 35g / L) + 1.521 * soft pancreatic texture)]; operative bleeding (> 400 m1) (OR = 4.412), pancreatic fistula (> 55.773) and biliary fistula (> OR = 29.791) were independent risk factors for postoperative abdominal infection. The predictive equations of cavity infection were: P = 1 /[1 decae - (- 5.191 + 4.021 * pancreatic fistula + 1.484 * operative bleeding (> 400 ml) + 3394 + bile leakage]; postoperative serum albumin (35 g / L) (OR = 5.379), common bile duct diameter (1.5 cm) (OR = 3.013) and pancreatic fistula (OR = 8.397) were independent risk factors for postoperative biliary fistula. The predictive equations for biliary fistula were: P = 1 /[1 decae - (- 4.693 + 1.682 *). Albumin (35g/L) + 1.103 common bile duct diameter (1.5cm) + 2.128 * pancreatic fistula]; alcoholism history (OR = 3.215), diabetes mellitus (OR = 4.335) and surgical procedure (PPPD) (OR = 7.797) were risk factors for postoperative gastroparesis. The predictive equation for gastroparesis was: P = 1 /[10 e - (- 4.261 + 1.168 * alcoholism history + 1467 * diabetes + 2.054 * surgical procedure (PPPD)]; and the risk factors for abdominal bleeding were: P = 1 /[10 e - (- 4.261 + 1.168 * alcoholism + 1467 The predictive equations of operative bleeding (> 400 m1) (OR = 9.987), anastomotic fistula (OR = 6.619) and preoperative hemoglobin (100 g / L) (OR = 5.860) were: P = 1 /[10 e - (- 4.852 + 2.301 * operative bleeding (> 400 ml) + 1.890 + anastomotic fistula + 1.768 * hemoglobin 100 g / L)]; age (> 65) (OR = 19.076), abdominal infection (OR = 4.971) and abdominal hemorrhage (OR = 23.56). 1) It is an independent risk factor for early postoperative mortality. The predictive equation of early postoperative mortality is: P = 1 /[10e - (- 5.817 + 1.604 * abdominal infection + 3.16 * abdominal hemorrhage + 2.948 * age (> 65)]. Postoperative pancreatic fistula was an independent risk factor; operative bleeding (> 400m1), pancreatic fistula and biliary fistula were independent risk factors for postoperative abdominal infection; postoperative serum albumin (35g/L), common bile duct diameter (1.5cm) and pancreatic fistula were independent risk factors for postoperative biliary fistula; alcoholism history, diabetes mellitus and surgical procedure (PPPD) were risk factors for postoperative gastroparesis; The risk factors of blood were operative bleeding (>400m1), anastomotic leakage and preoperative hemoglobin (>100g/L); age (>65), abdominal infection and abdominal hemorrhage were independent risk factors for early postoperative death. Therefore, correcting and improving preoperative patients'physical condition, careful treatment during operation and strengthening postoperative care can reduce the complications to a certain extent. Happen.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.5

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