老年患者胰十二指肠切除术后并发症及其危险因素分析

目的 探讨老年患者胰十二指肠切除术（PD）后并发症及其危险因素。方法 回顾性分析2010年1月至2013年1月接受胰十二指肠切除术的老年患者的临床资料,对患者术后并发症的发生情况及其危险因素进行统计分析。结果 本组共65例,均顺利完成手术,术后并发腹腔感染13例、胰漏9例、腹腔出血4例、胆漏4例、胃排空障碍2例、切口感染2例、肺部感染2例、上消化道出血1例、胸腔积液1例,术后总并发症发生率41.5%（27/65）。患者PD术后1个月内死亡5例,病死率7.7%（5/65）。多变量logistic回归分析显示术后总并发症发生的独立危险因素为胰腺质软和胰管直径＜3 mm（P＜0.05）;腹腔感染的独立危险因素为术中出血≥400 ml和胰腺质软;胰漏的独立危险因素为手术时间＞360 min、胰腺质软和胰管直径＜3 mm（P＜0.05）。结论 老年并非是胰十二指肠切除术禁忌,胰腺质软和胰管直径＜3 mm是术后并发症发生的独立危险因素。

An analysis of post-operative complications and its risk factors following pancreaticoduodenectomy in the elderly patients

Objective To investigate the complications and its risk factors following pancreatoduodenectomy （PD） in the elderly patients. Methods Clinicopathological data of 65 elderly patients （age≥65 years）, who were subject to PD in The First Affiliated Hospital, Sun Yat-Sen University between January 2010 and January 2013, were retrospectively analyzed. The post-operative complications and its risk factors were analyzed by uni-variate and multi-variate logistic analysis. Results There were 65 patients in the present series, and PD was successfully performed in all patients. The postoperative complications included intra-abdominal infection in 13, pancreatic leakage in 9, intra-abdominal bleeding in 4, bile leakage in 4, delayed gastric emptying in 2, wound infection in 2, pulmonary infection in 2, upper gastrointestinal bleeding in 1 and hydrothorax in 1, with the postoperative complications incidence of 41.5% （27/65）. Five patients died within 1 month after operation, with a mortality of 7.7% （5/65）. Multivariate logistic regression analysis revealed that independent risk factors for postoperative complications were soft texture of remnant pancreas and pancreatic duct diameter smaller than 3 mm （P＜0.05）. Independent risk factors for postoperative intra-abdominal infection included intra-operative bleeding ≥400 ml and soft texture of remnant pancreas （P＜0.05）. Independent risk factors for postoperative pancreatic leakage were operative time 〉360 min, soft texture of remnant pancreas and pancreatic duct diameter smaller than 3 mm （P＜0.05）. Conclusions Senile age was not the contraindication for PD. The independent risk factors for post-operative morbidities were soft texture of remnant pancreas and pancreatic duct diameter smaller than 3 mm.