• 1.四川大學(xué)華西醫(yī)院普外科(成都610041);;
  • 2.溫州醫(yī)學(xué)院附屬第三醫(yī)院外一科(浙江瑞安325200);

【摘要】目的  多因素分析胰十二指腸切除(PD)術(shù)后并發(fā)癥及死亡危險(xiǎn)因素。方法  233例行PD手術(shù)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?chē)鷲盒阅[瘤138例。有重要器官系統(tǒng)合并癥59例。根據(jù)病變部位分為胰腺組(81例)和壺腹周?chē)M(152例)。結(jié)果  術(shù)后發(fā)生并發(fā)癥63例（27.0%），早期并發(fā)癥58例（24.9%），感染并發(fā)癥28例（12.0%），多器官功能障礙15例（6.4%），出血并發(fā)癥14例（6.0%），胰瘺12例（5.2%），再手術(shù)15例（6.4%），住院死亡16例（6.9%）。多因素分析提示，術(shù)后并發(fā)癥的獨(dú)立危險(xiǎn)因素有重要臟器合并癥、手術(shù)方式、主胰管直徑及手術(shù)者經(jīng)驗(yàn)。住院死亡的獨(dú)立危險(xiǎn)因素有術(shù)前血Cr水平、重要臟器合并癥及手術(shù)者經(jīng)驗(yàn)。再手術(shù)的獨(dú)立危險(xiǎn)因素有術(shù)前CA19-9水平、手術(shù)者經(jīng)驗(yàn)、病灶直徑及淋巴結(jié)轉(zhuǎn)移。胰瘺的獨(dú)立危險(xiǎn)因素有Whipple術(shù)式、主胰管直徑及手術(shù)者經(jīng)驗(yàn)。結(jié)論  重要臟器合并癥及手術(shù)者經(jīng)驗(yàn)是PD術(shù)后并發(fā)癥和住院死亡的獨(dú)立危險(xiǎn)因素； 手術(shù)方式、主胰管直徑及手術(shù)者經(jīng)驗(yàn)是胰瘺的獨(dú)立危險(xiǎn)因素。因此，PD適應(yīng)證及術(shù)式選擇和技術(shù)的完善對(duì)于減少術(shù)后并發(fā)癥及住院死亡至關(guān)重要。

引用本文： 劉戰(zhàn)培,蒲青凡,周勇. 233例胰十二指腸切除術(shù)后并發(fā)癥及死亡危險(xiǎn)因素多因素分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(3): 195-200. doi: 復(fù)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(lái)喜， 余少鴻， 何振平. 胰十二指腸切除術(shù)后嚴(yán)重并發(fā)癥的防治體會(huì) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2006； 13（6）∶714.
14. 彭承宏， 程?hào)|峰， 沈柏用， 等. 胰十二指腸切除術(shù)聯(lián)合血管切除的術(shù)前、術(shù)中評(píng)估和操作要點(diǎn) [Ｊ]. 中國(guó)普外基礎(chǔ)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. 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. 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. 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. 4. Aerts R, Hendrickx T, Fieuws S, et al. Determinants of complications in pancreaticoduodenectomy [Ｊ]. Eur J Surg Onco, 2007; 33(4)∶448.
  5. 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. 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. 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. 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. 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. 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. 11. Aranha GV, Aaron JM, Shoup M, et al. Current management of pancreatic fistula after pancreaticoduodenectomy [Ｊ]. Surgery, 2006; 140(4)∶561.
  12. 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. 13. 徐來(lái)喜， 余少鴻， 何振平. 胰十二指腸切除術(shù)后嚴(yán)重并發(fā)癥的防治體會(huì) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2006； 13（6）∶714.
  14. 14. 彭承宏， 程?hào)|峰， 沈柏用， 等. 胰十二指腸切除術(shù)聯(lián)合血管切除的術(shù)前、術(shù)中評(píng)估和操作要點(diǎn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2006； 13（5）∶506.
  15. 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. 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. 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. 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. 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. 20. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition [Ｊ]. Surgery, 2005; 138(1)∶8.