高龄病人实施胰十二指肠切除术危险因素的分析

目的：以实施胰十二指肠切除术的高龄病人，对照非高龄病人，分析术后发生并发症和死亡的原因，寻找高龄（〉70岁）病人发生术后并发症和死亡的危险因素。方法：回顾性分析164例连续的胰十二指肠切除术的病例资料，对其中高龄病人术前、术中和术后发生并发症和造成死亡的可能危险因素进行统计分析，判断这些因素与术后并发症及死亡的关系。结果：高龄病人在术前ASA评分、心功能分级上显著区别于非高龄（≤70岁）病人；且高龄病人术前心血管并存症也多于后者。高龄病人的术后院内死亡率高于非高龄病人，这些死亡的发生多出现在术后30d以后；高龄组和非高龄组中，术后并发症的发生率并无显著差异。单因素分析术后发生并发症的危险因素发现．术前低蛋白血症、术中失血大于1000mL是两大主要因素。而高龄病人术后院内死亡的危险因素是术后并发症、术前低蛋白血症和术前心功能分级〉2。结论：高龄病人胰十二指肠切除术后病死率较高，与其术前并存症及术前营养情况相关。术前改善高龄病人的营养状况，术中减少创伤和出血，加强术后重症监护及治疗、积极处理并存症和并发症是降低术后并发症和术后死亡发生的有效手段。

Analysis of the risk factors for pancreaticoduodenectomy in the elderly

Objective To assess the causes of death and complications after pancreatieoduodenectomy in the elderly （〉70 years old）, and try to reduce the morbidity and mortality after the procedure. Methods The data of 164 consecutive cases undergoing pancreaticoduodenectomy were reviewed retrospectively to analyze factors involving with their general condition, operation and post-operative satus, and to find out which are the dangerous factors causing mortality and morbidity in the elderly after pancreaticoduodenectomy. Statistical evidence was completed with SPSS software. Results There were significant differences in preoperative ASA, and grades of heart function between the elderly patients and the younger patients （≤70 years old）, and there was more co-morbidity concerning coronary heart disease in the elderly patients. There was a higher mortality in the elderly after 30 days of postoperation. No significant difference was noted in the incidence of morbidity between the two groups. By univariate analysis of the risk factors, both preoperative low serum albumin level and a loss of blood more than 1 000 mL during the operation were significant enhaneing factors for postoperative complications. With morbidty, preoperative low serum albumin level, co-morbidity of coronary heart disease and the grade of heart function 〉2 were often associated a higher mortality in the elderly. Conclusions The age factor is not an absolute contraindication for pancreatieoduodenectomy. There are the effective ways to reduce the incidence of postoperative morbidity and mortality： amelioration of the nutritional status before operation, building an effective professional team, reduction of blood loss during the operation, and treatment of postoperative complications in the ICU.