胰十二指肠切除术在高龄患者中的应用(英文)

目的评估胰十二指肠切除术在75岁以上高龄患者中应用的指征和结果。方法回顾性分析72例在2002-01～2006-12进行胰十二指肠切除术患者的临床资料,将其中18例75岁及以上的高龄患者与54例小于75岁的患者的术前、术中、术后的临床资料和病理结果等情况进行归纳、对比分析。结果两组患者在性别、术前合并症、术中出血量、手术时间、术后并发症、死亡率、ICU留观时间和住院时间等方面无统计学差异;高龄组患者中没有输入新鲜冷冻血浆,而非高龄组患者术中平均输入(1.33±2.54)单位新鲜冷冻血浆(P<0.001);高龄组没有发生术后出血的并发症,两组腹腔内感染率均为4%;高龄组患者再次开腹手术率为0%,而非高龄组为6%(P>0.05),两组均未出现死亡病例。高龄组胆管癌所占比例明显高于非高龄组(55.6%vs 25.9%,P=0.021)。结论 75岁以上高龄患者和小于75岁的患者一样能够耐受胰十二指肠切除术,并能从中获益;高龄的壶腹周围肿瘤患者中,胆管癌的发病率最高,提示在对高龄人群进行体检或疾病筛查时,要高度重视对胆道系统的详细检查。

Pancreaticoduodenectomy in elderly patients

Objective To assess the indications and the outcomes of pancreaticoduodenectomy in patients aged 75 years and over.Methods From January,2002 to December 2006,the data of 72 patients undergoing pancreaticoduodenectomy were retrospectively analyzed.The pre-,intra- and postoperative data of 18 patients aged 75 years and over(older group) were compared with findings in 54 younger patients(younger group).Results The two groups were statistically similar with respect to sex,preoperative comorbidity,intraoperative blood loss,operative time,postoperative complication rate,mortality rate,and postoperative length of intensive care unit(ICU) stay and hospital stay.No intraoperative transfusion of fresh frozen plasma(FFP) was used in patients aged 75 years and over,while average units of intraoperative FFP transfusion was (1.33±2.54) units in the younger patients(P<0.001).The postoperative haemorrhagic complications was not found in older group after pancreaticoduodenectomy,and the rate of intra-abdominal abscess was 3.7% in both two groups(P>0.05,respectively).The relaparotomy rate was 0 in older group and 6% in younger group(P>0.05).No patient died in both two groups.The incidence of distal bile duct adenocarcinoma was higher in older group than that in younger group(55.6% vs 25.9%,P=0.021).Conclusion Patients aged 75 years and over can benefit from pancreaticoduodenectomy similarly to younger patients.In elder patients with periampullary cancer,incidence rate of bile duct cancer is the highest.So doctors should pay more attention to the biliary system when elderly population receives health checkup or disease screening.