胰十二指肠切除术后胃排空延迟发生及严重程度的危险因素分析

目的分析胰十二指肠切除术后胃排空延迟发生及病情严重程度的危险因素。方法回顾性分析208例在我院进行胰十二指肠切除术患者的临床资料。采用多因素Logistic回归分析进行危险因素分析。结果术后83例出现胃排空延迟,发生率为39.90%,其中A级31例(14.90%),B级27例(12.98%),C级25例(12.02%)。保留幽门、Child法重建消化道、术中出血量≥1000 mL、手术时间≥360 min、术后腹部并发症术后胃排空延迟的发生率更高(P<0.05),其中Child法、术中出血量、术后腹部并发症是胃排空延迟发生的独立危险因素(P<0.05)。术后年龄≥60岁、保留幽门、手术时间≥360 min、术后腹部并发症术后胃排空延迟病情更严重(P<0.05),其中年龄、术后腹部并发症是胃排空延迟病情严重程度的独立危险因素(P<0.05)。结论胰十二指肠切除术后胃排空延迟发生率高,采用改进型消化道重建方式、减少术中出血量和术后腹部并发症有助于降低发生率;高龄和合并术后腹部并发症的患者发生胃排空延迟的严重程度明显增加。

Risk factors of occurrence and severity of delayed gastric emptying after pancreaticoduodenectomy

Objective To analyze delayed gastric emptying after pancreaticoduodenectomy occurrence and severity of risk factors. Methods Retrospectively analysis of 208 cases in our hospital pancreaticoduodenectomy clinical data. Multivariate logistic regression analysis was used for risk factor analysis. Results After 83 cases appear delayed gastric emptying, the rate was 39.90%, of which A grade 31 cases （14.90%）, B grade 27 cases （12.98%）, C grade 25 cases （12.02%）. Pylorus, Child Law reconstruction of digestive tract, blood loss ≥ 1000 mL, operative time ≥ 360 min, postoperative complications after abdominal higher incidence of delayed gastric emptying （P 〈 0.05）, which Child, bleeding, postoperative abdominal complications were delayed gastric emptying independent risk factors （P 〈 0.05）. Patients aged I〉 60 years, pylorus-preserving operation time ≥ 360 min, postoperative complications after abdominal sieker delayed gastric emptying （P 〈 0.05）, in which age, delayed gastric emptying after abdominal complications were serious condition degree of independent risk factors （P 〈 0.05）. Conclusion Incidence of delayed gastric emptying after pancreaticoduodenectomy is high. Using improved ways of digestive tract reconstruction, reduce the intraoperative blood .loss and postoperative complications of the abdomen can help reduce the incidence; elderly and merge postoperative abdominal complications in patients with delayed gastric emptying severity increased significantly.