【摘要】：目的通過收集整理我院確診十二指腸乳頭癌且行十二指腸切除術(shù)治療的85例患者的臨床及病理資料,分析十二指腸乳頭癌術(shù)后并發(fā)癥的危險(xiǎn)因素,并探討消化道重建時(shí)附加布朗吻合與術(shù)后并發(fā)癥相關(guān)性。為行胰十二指腸切除術(shù)治療十二指腸乳頭癌患者術(shù)后并發(fā)癥的防治提供理論依據(jù)及臨床參考資料。方法收集廣西醫(yī)科大學(xué)一附院2013年1月到2017年1月期間行胰十二指腸切除術(shù)治療的85例十二指腸乳頭癌患者的臨床病例資料。均經(jīng)胃鏡及病理學(xué)確診后行標(biāo)準(zhǔn)胰十二指腸切除術(shù),所有患者行Child式重建,以年齡、性別、手術(shù)時(shí)間、出血量、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、是否行布朗吻合、胰腺質(zhì)地等為觀察因素,以術(shù)后胰瘺、出血、感染為因變量。對臨床資料進(jìn)行單因素統(tǒng)計(jì)分析,對于有統(tǒng)計(jì)意義的變量再引入二分類非條件逐步Logistic回歸模型進(jìn)行多因素分析,確定獨(dú)立的危險(xiǎn)因素。結(jié)果1.85例十二指腸乳頭癌患者行胰十二指腸切除術(shù)后1個(gè)月內(nèi)出現(xiàn)并發(fā)癥者有30例(35.3%),分布為胰瘺9例,出血10例,感染11例,分別占10.6%、11.8%、12.9%。2.經(jīng)統(tǒng)計(jì)學(xué)單因素分析得到:性別(男)、術(shù)前低血紅蛋白(90g/L)、胰腺質(zhì)地正常、無布朗吻合是胰瘺發(fā)生的危險(xiǎn)因素;年齡≥70歲、術(shù)前高膽紅素≥171umol/L、術(shù)后胰瘺、術(shù)后腹腔感染為術(shù)后出血的危險(xiǎn)因素;年齡≥70歲、糖尿病、術(shù)前白蛋白30g/L、術(shù)前低血紅蛋白(90g/L)、術(shù)前術(shù)后輸血、留置胃管時(shí)間5天、術(shù)中出血量≥800ml是術(shù)后感染的危險(xiǎn)因素。經(jīng)統(tǒng)計(jì)學(xué)Logistic多變量分析得到:胰腺質(zhì)地正常、無布朗吻合是胰瘺發(fā)生的獨(dú)立危險(xiǎn)因素;術(shù)前高膽紅素、術(shù)后胰瘺、腹腔感染是術(shù)后出血的獨(dú)立危險(xiǎn)因素;糖尿病是術(shù)后感染的獨(dú)立危險(xiǎn)因素(所有P0.05)。結(jié)論胰腺質(zhì)軟的患者更容易發(fā)生胰瘺,布朗吻合可有效減少胰瘺的發(fā)生率。術(shù)后出血在存在術(shù)前高膽紅素、術(shù)后胰瘺和術(shù)后腹腔感染的患者中更易出現(xiàn),術(shù)后感染在合并糖尿病患者中更容易出現(xiàn)。
[Abstract]:Objective to analyze the risk factors of postoperative complications of duodenal papillary carcinoma by collecting clinical and pathological data of 85 patients with duodenal papillary carcinoma diagnosed and treated by duodenectomy in our hospital. To explore the correlation between postoperative complications and additional Brownian anastomosis during digestive tract reconstruction. To provide theoretical basis and clinical reference for the prevention and treatment of postoperative complications in patients with carcinoma of duodenal papilla by pancreaticoduodenectomy. Methods the clinical data of 85 patients with duodenal papillary carcinoma treated by pancreaticoduodenectomy from January 2013 to January 2017 in the affiliated Hospital of Guangxi Medical University were collected. All patients underwent standard pancreatoduodenectomy after gastroscopy and pathology. All patients underwent Child reconstruction with age, sex, operation time, blood loss, preoperative serum total bilirubin level and preoperative serum albumin level. Preoperative hemoglobin level, brown anastomosis and pancreas texture were observed. Postoperative pancreatic fistula, hemorrhage and infection were dependent variables. Univariate statistical analysis of clinical data and multivariate analysis of two unconditioned stepwise Logistic regression models for statistical variables were carried out to determine independent risk factors. Results 1.There were 30 cases (35.3%) with complications within one month after pancreatoduodenectomy in 85 patients with duodenal papillary carcinoma, 9 cases were pancreatic fistula, 10 cases were hemorrhage, 11 cases were infection, accounting for 10.6% (11.8%), respectively. 12.90.2. Single factor analysis showed that sex (male), preoperative low hemoglobin (90g/L), normal pancreas texture and no Brownian anastomosis were risk factors for pancreatic fistula. Age 鈮，

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