胰十二指肠切除术后应激性溃疡出血的危险因素分析

目的 探讨胰十二指肠切除术后发生应激性溃疡出血的危险因素.方法 对285例壶腹周围癌患者行胰十二指肠切除手术,分析患者的临床特点、手术情况、病理结果、术后治疗和术后篌并发症等,以未发生应激性溃疡出血患者为对照组,研究发生应激性溃疡出血的危险因素.结果 全组发生应激性溃疡出血35例,其中胰腺癌5例,十二指肠癌8例,胆总管下端癌10例,壶腹癌11例,实性假乳头状瘤1例.单因素分析结果显示,饮酒史、术前高胆红索水平、手术时间、淋巴结转移、术后出现其他并发症和术后前白蛋白降低是术后发生应激性溃疡出血的影响因素(均P<0.05).Logisitic回归分析显示,术前高胆红索水平、手术时间、术后出现其他并发症和术后前白蛋白降低是胰十二指肠切除术后发生应激性溃疡出血的独立危险因素(均P<0.05).结论 应激性溃疡出血已成为胰十二指肠切除术常见并发症之一,术前高胆红素水平、手术时间、术后其他并发症和术后前白蛋白降低是发生应激性溃疡出血的危险因素.

Analysis of risk factors of stress-related ulcer and gastrointestinal hemorrhage after pancreaticoduodenectomy

Objective To assess the risk factors of stress-related ulcer and gastrointestinal hemorrhage after pancreaticoduodenectomy. Methods From May 1999 to July 2007, 285 periampullary cancer patients underwent pancreaticoduodenectomy in our hospital. The clinical data, pathological results,type of operation, and postoperative treatment were retrospectively analyzed. Patients with stress-related ulcer and gastrointestinal hemorrhage were selected for risk factor analysis, and other patients were taken as control group. Results 35 paitents ( 12.3% ) developed stress-related ulcer and gastrointestinal hemorrhage following pancreaticoduodenectomy. Pathological examination showed pancreatic cancer in 5 cases, duodenal cancer in 8, common bile duct cancer in 10, ampullary carcinoma in 11, and solidpseudopapillary tumors in 1. Single variate analysis demonstrated that alcohol, preoperative bilirubin level,operation time, lymph node metastasis, prealbumin decrease after operation and other complication were significently associated with the stress-related ulcer and gastrointestinal hemorrhage. Logisitic regression in multivariate analysis revealed that preoperative bilirubin level, operation time, other complication,prealbumin decrease after surgery were independent risk factors. Conclusion Stress-related ulcer and gastrointestinal hemorrhage are one of the most common complications after pancreaticoduodenectomy.Preoperative bilirubin level, operation time, other complications, and prealbumin decrease after operation are four independently risk factors.