胰十二指肠切除术后胃排空延迟的因素分析

目的　明确影响胰十二指肠切除术后胃排空延迟形成的因素。方法　回顾性分析1994年12月至2 0 0 3年12月接受胰十二指肠切除术的12 3例患者的病历资料。结果　胃排空延迟的发生率为2 1.1% (2 6/12 3 )。单变量分析表明:手术失血量、手术方式、近端空肠切除长度、胆瘘、腹腔感染、术后白蛋白水平、术后排气时间、术后前3d日均胃液引流量及胆汁引流量为有意义的相关因素;经Logistic回归多变量分析,确定了6个独立与胃排空延迟相关的变量:腹腔感染、手术方式、手术失血量、术后排气时间、术后前3d日均胃液引流量及胆汁引流量。结论　腹腔感染、保留幽门的胰十二指肠切除术及手术失血量≥10 0 0ml是胰十二指肠切除术后胃排空延迟发生的重要影响因素;胃排空延迟伴随有术后排气时间延长、术后前3d胃液引流量增多及胆汁引流量减少。

Analysis of factors influencing delayed gastric emptying after pancreatoduodenectomy

Objective To determine the factors influencing the development of delayed gastric emptying (DGE) after pancreatoduodenectomy (PD).Methods The data of 123 consecutive patients undergone PD from Dec.1994 to Dec.2003 were analyzed retrospectively.Results The incidence of DGE was 21.1%(26/123).Univariate analysis showed amount of blood loss, operative procedure,length of removed proximal jejunum,biliary fistula,intraabdomianal infection,postoperative serum albumin concentration,postoperative gas passage, average volume of gastric and biliary drainage every day during the first 3 postoperative days were significantly associated with DGE.Multivariate analysis using logistic regression identified 6 variables as independent factors associated with DGE:intraabdomianal infection (P=0.017),operative procedure (P<0.001),amount of blood loss (P=0.001),postoperative gas passage (P=0.003),average volume of gastric and biliary drainage every day during the first 3 postoperative days (P=0.002,P=0.030).Conclusion Intraabdomianal infection, PPPD and operative blood loss more than or equal to 1 000 ml play an important role in the development of DGE after PD.These patients manifest prolonged postoperative gas passage,increased average volume of gastric drainage every day during the first 3 postoperative days and decreased biliary drainage.