233例胰十二指腸切除術后并發癥及死亡危險因素多因素分析_《中國普外基礎與臨床雜志》

作者：

劉戰培 , 蒲青凡 , 周勇

1.四川大學華西醫院普外科(成都610041);;
2.溫州醫學院附屬第三醫院外一科(浙江瑞安325200);

關鍵詞：

胰十二指腸切除術,術后并發癥,危險因素

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【摘要】目的多因素分析胰十二指腸切除(PD)術后并發癥及死亡危險因素。方法 233例行PD手術患者，平均年齡56歲; 惡性病變210例，良性病變23例; 胰頭惡性腫瘤72例，壺腹周圍惡性腫瘤138例。有重要器官系統合并癥59例。根據病變部位分為胰腺組(81例)和壺腹周圍組(152例)。結果術后發生并發癥63例（27.0%），早期并發癥58例（24.9%），感染并發癥28例（12.0%），多器官功能障礙15例（6.4%），出血并發癥14例（6.0%），胰瘺12例（5.2%），再手術15例（6.4%），住院死亡16例（6.9%）。多因素分析提示，術后并發癥的獨立危險因素有重要臟器合并癥、手術方式、主胰管直徑及手術者經驗。住院死亡的獨立危險因素有術前血Cr水平、重要臟器合并癥及手術者經驗。再手術的獨立危險因素有術前CA19-9水平、手術者經驗、病灶直徑及淋巴結轉移。胰瘺的獨立危險因素有Whipple術式、主胰管直徑及手術者經驗。結論重要臟器合并癥及手術者經驗是PD術后并發癥和住院死亡的獨立危險因素；手術方式、主胰管直徑及手術者經驗是胰瘺的獨立危險因素。因此，PD適應證及術式選擇和技術的完善對于減少術后并發癥及住院死亡至關重要。

引用本文： 劉戰培,蒲青凡,周勇. 233例胰十二指腸切除術后并發癥及死亡危險因素多因素分析. 中國普外基礎與臨床雜志, 2008, 15(3): 195-200. doi: 復制

1.	20 Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula [Ｊ] . J Gastrointest Surg, 2004; 8(8) ∶ 951.
2.	Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: A 20-year experience in 516 patients [Ｊ]. Arch Surg， 2004; 139(7)∶718.
3.	Riall TS, Cameron JL, Lillemoe KD, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up [Ｊ]. Surgery, 2006; 140(5)∶764.
4.	Aerts R, Hendrickx T, Fieuws S, et al. Determinants of complications in pancreaticoduodenectomy [Ｊ]. Eur J Surg Onco, 2007; 33(4)∶448.
5.	Smith SL, Rae D, Sinclair M, et al. Does moderate celiac axis stenosis identified on preoperative multidetector computed tomographic angiography predict an increased risk of complications after pancreaticoduodenectomy for malignant pancreatic tumors? [Ｊ]. Pancreas, 2007; 34(1)∶80.
6.	Weinter JM, Cameron JL, Yeo CJ, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy [Ｊ]. J Am Coll of Surg, 2007; 204(5)∶1029.
7.	Suzuki Y, Fujino Y, Ajiki T, et al. No mortality among 100 consecutive pancreaticoduodenectomies in a middle-volume center [Ｊ]. World J Surg, 2005; 29(11)∶1409.
8.	Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients [Ｊ]. Surgery, 2006; 139(5)∶591.
9.	Kazanjian KK, Hines OJ, Eibl G, et al. Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients [Ｊ]. Arch Surg, 2005; 140(9)∶849.
10.	Wada K, Traverso LW. Pancreatic anastomotic leak after the Whipple procedure is reduced using the surgical microscope [Ｊ]. Surgery, 2006; 139(6)∶735.
11.	Aranha GV, Aaron JM, Shoup M, et al. Current management of pancreatic fistula after pancreaticoduodenectomy [Ｊ]. Surgery, 2006; 140(4)∶561.
12.	Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume [Ｊ]. Ann Surg, 2000; 232(6)∶786.
13.	徐來喜，余少鴻，何振平. 胰十二指腸切除術后嚴重并發癥的防治體會 [Ｊ]. 中國普外基礎與臨床雜志， 2006； 13（6）∶714.
14.	彭承宏，程東峰，沈柏用，等. 胰十二指腸切除術聯合血管切除的術前、術中評估和操作要點 [Ｊ]. 中國普外基礎與臨床雜志， 2006； 13（5）∶506.
15.	Satoi S, Takai S, Matsui Y, et al. Less morbidity after pancreaticoduodenectomy of patients with pancreatic cancer [Ｊ]. Pancreas, 2006; 33(1)∶45.
16.	Ferrone CR, Finkelstein DM, Thayer SP, et al. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma [Ｊ]. J Clin Oncol, 2006; 24(18)∶2897.
17.	Harvey J, Dardik H, Impeduglia T, et al. Endovascular management of hepatic artery pseudoaneurysm hemorrhage complicating pancreaticoduodenectomy [Ｊ]. J Vasc Surg, 2006; 43(3)∶613.
18.	Butturini G, Marcucci S, Molinari E, et al. Complications after pancreaticoduodenectomy: the problem of current definitions [Ｊ]. J Hepatobiliary Pancreat Surg, 2006; 13(3)∶207.
19.	Wente MN, Shrikhande SV, Kleeff J, et al. Management of early hemorrhage from pancreatic anastomoses after pancreaticoduodenectomy [Ｊ]. Dig Surg, 2006; 23(4)∶203.
20.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition [Ｊ]. Surgery, 2005; 138(1)∶8.

1. 20 Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula [Ｊ] . J Gastrointest Surg, 2004; 8(8) ∶ 951.
2. Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: A 20-year experience in 516 patients [Ｊ]. Arch Surg， 2004; 139(7)∶718.
3. Riall TS, Cameron JL, Lillemoe KD, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up [Ｊ]. Surgery, 2006; 140(5)∶764.
4. Aerts R, Hendrickx T, Fieuws S, et al. Determinants of complications in pancreaticoduodenectomy [Ｊ]. Eur J Surg Onco, 2007; 33(4)∶448.
5. Smith SL, Rae D, Sinclair M, et al. Does moderate celiac axis stenosis identified on preoperative multidetector computed tomographic angiography predict an increased risk of complications after pancreaticoduodenectomy for malignant pancreatic tumors? [Ｊ]. Pancreas, 2007; 34(1)∶80.
6. Weinter JM, Cameron JL, Yeo CJ, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy [Ｊ]. J Am Coll of Surg, 2007; 204(5)∶1029.
7. Suzuki Y, Fujino Y, Ajiki T, et al. No mortality among 100 consecutive pancreaticoduodenectomies in a middle-volume center [Ｊ]. World J Surg, 2005; 29(11)∶1409.
8. Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients [Ｊ]. Surgery, 2006; 139(5)∶591.
9. Kazanjian KK, Hines OJ, Eibl G, et al. Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients [Ｊ]. Arch Surg, 2005; 140(9)∶849.
10. Wada K, Traverso LW. Pancreatic anastomotic leak after the Whipple procedure is reduced using the surgical microscope [Ｊ]. Surgery, 2006; 139(6)∶735.
11. Aranha GV, Aaron JM, Shoup M, et al. Current management of pancreatic fistula after pancreaticoduodenectomy [Ｊ]. Surgery, 2006; 140(4)∶561.
12. Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume [Ｊ]. Ann Surg, 2000; 232(6)∶786.
13. 徐來喜，余少鴻，何振平. 胰十二指腸切除術后嚴重并發癥的防治體會 [Ｊ]. 中國普外基礎與臨床雜志， 2006； 13（6）∶714.
14. 彭承宏，程東峰，沈柏用，等. 胰十二指腸切除術聯合血管切除的術前、術中評估和操作要點 [Ｊ]. 中國普外基礎與臨床雜志， 2006； 13（5）∶506.
15. Satoi S, Takai S, Matsui Y, et al. Less morbidity after pancreaticoduodenectomy of patients with pancreatic cancer [Ｊ]. Pancreas, 2006; 33(1)∶45.
16. Ferrone CR, Finkelstein DM, Thayer SP, et al. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma [Ｊ]. J Clin Oncol, 2006; 24(18)∶2897.
17. Harvey J, Dardik H, Impeduglia T, et al. Endovascular management of hepatic artery pseudoaneurysm hemorrhage complicating pancreaticoduodenectomy [Ｊ]. J Vasc Surg, 2006; 43(3)∶613.
18. Butturini G, Marcucci S, Molinari E, et al. Complications after pancreaticoduodenectomy: the problem of current definitions [Ｊ]. J Hepatobiliary Pancreat Surg, 2006; 13(3)∶207.
19. Wente MN, Shrikhande SV, Kleeff J, et al. Management of early hemorrhage from pancreatic anastomoses after pancreaticoduodenectomy [Ｊ]. Dig Surg, 2006; 23(4)∶203.
20. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition [Ｊ]. Surgery, 2005; 138(1)∶8.

《中國普外基礎與臨床雜志》

233例胰十二指腸切除術后并發癥及死亡危險因素多因素分析

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《中國普外基礎與臨床雜志》

233例胰十二指腸切除術后并發癥及死亡危險因素多因素分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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