基于统一定义分析胰十二指肠切除术后腹部并发症的危险因素

目的 基于统一定义分析胰十二指肠切除(pD)术后腹部并发症的危险因素.方法 回顾性分析我院2001年1月～2010年7月间295例PD术的临床资料,采用国际胰腺外科研究协作组和中华医学会外科学分会胰腺外科学组制定的标准诊断腹部并发症,并用Logistic多因素回归分析腹部并发症的危险因素.结果 总的腹部并发症发生率为45.4％,病死率为3.4％,再手术率为5 1％.胃排空延迟49例(16.6％),胰瘘37例(12.5％),出血18例(6.1％),腹腔感染16例(5.4％),切口感染或裂开8例(2.7％),胆瘘4例次(1.4％),胃肠吻合口瘘1例(0.3％),不全性肠梗阻1例(0.3％).Logistic多因素回归分析结果显示,胰腺质地(OR=3.310)和胰管直径( OR=2.278)是胰瘘的独立危险因素；胰瘘(OR=2.945)和术前高胆红素水平(OR=1.062)是出血的独立危险因素；胰瘘( OR=2.104)和腹腔感染(OR=1.326)是B/C级胃排空延迟的独立危险因素；消化道瘘(OR=1.965)是腹腔感染的独立危险因素.结论 临床上推行统一定义来评价PD术后并发症,有助于并发症的诊治,也有利于学术交流.针对各自危险因素,采取有效的预防措施,有望减少PD术腹部并发症的发生.

Analysis of risk factors of intra-abdominal complications after pancreaticoduodenectomy based on an uniform definition

【Objective】 To investigate the intra-abdominal complications(IACs) and its main risk factors after pancreaticoduodenectomy(PD) based on an uniform definition.【Methods】 A retrospective analysis was made on 295 cases who underwent PD from Janunary 2001 to July 2010.The diagnosis of IACs was based on an uniform definition suggested by International Study Group of Pancreatic Surgery and Pancreatic Surgery Group of Chinese Medical Association Surgery Branch,and the risk factors of IACs were analyzed by multivariate logistic regression analysis.【Results】 The overall rate of IACs was 45.4%.The overall mortality was 3.4% and the re-laparotomy rate was 5.1%.The IACs included 49(16.6%) cases of delayed gastric emptying,37(12.5%) pancreatic fistula,18(6.1%) hemorrhage,16(6.1%) intra-abdominal infection,8(3.4%) incision infection or dehiscence,4(1.4%) bile leakage,1(1.4%) gastrointestinal fistula and 1(1.4%) ileus.In multivariate analysis,pancreatic duct diameter(OR=3.310) and parenchyma texture(OR=2.278) were independent risk factors for pancreatic fistula,pancreatic fistula(OR=2.945) and high serum bilirubin level(OR=1.062) were independent risk factors for hemorrhage,pancreatic fistula(OR=2.104) and intra-abdominal infection(OR=1.326) were independent risk factors for B/C grade delayed gastric emptying,and digestive tract fistula(OR=1.965) was independent risk factor for intra-abdominal infection.【Conclusion】 The usage of uniform definition is useful for the diagnosis and treatment of complications after PD,and benefit for academic exchange.Effective prevention aimed at its risk factors is helpful to decrease IACs after PD.