【摘要】：高位膽道系統(tǒng)惡性腫瘤根治性手術(shù)后發(fā)生并發(fā)癥的危險(xiǎn)因素分析目的:探討高位膽道系統(tǒng)惡性腫瘤患者行根治性手術(shù)后出現(xiàn)并發(fā)癥的危險(xiǎn)因素。方法:收集2013年9月—2015年12月期間在南京鼓樓醫(yī)院肝膽胰外科行根治性手術(shù)治療的45例高位膽道系統(tǒng)惡性腫瘤患者的病例資料,統(tǒng)計(jì)其手術(shù)后各類并發(fā)癥,以術(shù)后是否出現(xiàn)嚴(yán)重并發(fā)癥和是否發(fā)生感染相關(guān)并發(fā)癥分別進(jìn)行分組,通過回歸分析探討其根治性術(shù)后出現(xiàn)并發(fā)癥的危險(xiǎn)因素。結(jié)果:45例高位膽系惡性腫瘤患者的根治性術(shù)后未出現(xiàn)住院期間死亡病例,其術(shù)后嚴(yán)重并發(fā)癥發(fā)生率22%(10/45),感染相關(guān)并發(fā)癥和膽漏的發(fā)生率則分別為56%(25/45)、29%(13/45)。經(jīng)多因素回歸分析證實(shí),術(shù)后第一天血清總膽汁酸是高位膽系惡性腫瘤患者行根治性治療后出現(xiàn)嚴(yán)重并發(fā)癥的獨(dú)立危險(xiǎn)因素(OR=1.170,95%CI=1.028～1.331,P = 0.02);其預(yù)測(cè)術(shù)后發(fā)生嚴(yán)重并發(fā)癥的最佳陽性參考值為6.6μmol/L,此時(shí)靈敏度、特異度分別是0.80、0.83。而患者術(shù)后出現(xiàn)感染并發(fā)癥的獨(dú)立預(yù)測(cè)因素則是術(shù)前引流減黃(OR=5.091,95%CI=1.319～19.649,P = 0.02)。結(jié)論:高位膽道系統(tǒng)惡性腫瘤患者行根治性手術(shù)后第一天的血清TBA是預(yù)測(cè)術(shù)后嚴(yán)重并發(fā)癥的獨(dú)立危險(xiǎn)因素,其診斷的最佳參考值為6.6μmol/L。而術(shù)前膽汁外引流是術(shù)后感染并發(fā)癥的獨(dú)立預(yù)測(cè)因素。E-PASS和POSSUM評(píng)分對(duì)肝門部膽管癌患者術(shù)后并發(fā)癥發(fā)生的預(yù)測(cè)價(jià)值比較目的:探討用于并發(fā)癥率計(jì)算的生理功能與手術(shù)應(yīng)激(E-PASS)評(píng)分、生理學(xué)和手術(shù)嚴(yán)重程度評(píng)分(POSSUM)系統(tǒng)對(duì)肝門部膽管癌術(shù)后并發(fā)癥發(fā)生的預(yù)測(cè)價(jià)值。方法:回顧性分析2010年9月至2016年03月間由同一治療小組施行根治性手術(shù)切除的42例肝門部膽管癌患者,收集各項(xiàng)臨床數(shù)據(jù),應(yīng)用E-PASS和POSSUM評(píng)分系統(tǒng)預(yù)測(cè)術(shù)后并發(fā)癥發(fā)生率。結(jié)果:42例患者根治性手術(shù)圍手術(shù)期死亡率0%,術(shù)后總并發(fā)癥發(fā)生率81%(34/42)。有并發(fā)癥組和無并發(fā)癥組間的術(shù)前風(fēng)險(xiǎn)評(píng)分(PRS)、綜合風(fēng)險(xiǎn)評(píng)分(CRS)及Y預(yù)測(cè)值存在明顯的統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后發(fā)生并發(fā)癥與Y預(yù)測(cè)值(Spearman系數(shù)=0.415,P= 0.006)、PRS(Spearman 系數(shù)=0.373,P= 0.015)、CRS(Spearman系數(shù)=0.415,P=0.006)之間存在正相關(guān)關(guān)系,并且PRS和術(shù)后并發(fā)癥的嚴(yán)重程度密切相關(guān)(Spearman系數(shù)=0.383,P= 0.012)。E-PASS和POSSUM評(píng)分系統(tǒng)預(yù)測(cè)術(shù)后并發(fā)癥對(duì)應(yīng)的ROC曲線下面積分別是 0.805(95%CI=0.660～0.950,P0.05=和 0.684(95%CI=0.511～0.856,P0.05)。E-PASS評(píng)分系統(tǒng)中的CRS對(duì)預(yù)測(cè)術(shù)后發(fā)生并發(fā)癥的最佳陽性參考值為0.334,CRS≥0.334則為高風(fēng)險(xiǎn)。結(jié)論:E-PASS評(píng)分系統(tǒng)較POSSUM能更有效地預(yù)測(cè)肝門部膽管癌根治性手術(shù)后并發(fā)癥的發(fā)生,并且其中的術(shù)前風(fēng)險(xiǎn)評(píng)分(PRS)與并發(fā)癥的嚴(yán)重程度密切相關(guān)。
[Abstract]:Analysis of risk factors of complications after radical operation for malignant tumors of high bile duct objective: to investigate the risk factors of complications in patients with malignant tumors of high bile duct system after radical operation. Methods: from September 2013 to December 2015, 45 patients with malignant tumors of high bile duct system who underwent radical surgery in the Department of Hepatobiliary and Pancreatic surgery of Nanjing Gulou Hospital were collected, and the complications after operation were counted. The risk factors of complications after radical operation were discussed by regression analysis according to whether serious complications occurred after operation and infection related complications. Results: 45 patients with high bile malignant tumor did not die during hospitalization after radical operation, and the incidence of serious postoperative complications was 22% (10 鈮，

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