CAJ | 학술논문

目的：分析影响胰十二指肠切除（PD）术后发生并发症的危险因素。方法对中山大学附属第一医院2000年1月至2009年12月施行PD手术的339例患者的临床资料进行回顾性分析，根据术后是否发生并发症分成为并发症组（n＝112）和无并发症组（n＝227）。对可能引起并发症的因素进行单因素和多因素统计分析。结果112例发生并发症（33.0%）。术后并发症包括：胰瘘29例（8.6%），上消化道出血24例（7.1%），腹腔感染20例（5.9%），伤口感染21例（6.2%），胸腔积液5例（1.5%），膈下积液4例（1.2%），肺部感染4例（1.2%），胆瘘4例（1.2%），腹腔出血4例（1.2%），胃排空障碍4例（1.2%），呼吸衰竭1例（0.3%），淋巴瘘1例（0.3%），肠道真菌感染1例（0.3%），心功能不全2例（0.6%），脓毒血症1例（0.3%），肠梗阻1例（0.3%）。经单因素分析表明两组患者术中出血量＞1000 ml和术中输血浆＞1000 ml存在统计学差异（P＜0.05﹚。对以上因素进行多自变量Logistic回归分析，显示术中出血量＞1000 ml是PD术后发生并发症的独立危险因素（P＝0.024，OR＝2.265，95%CI：1.113～4.608）。结论手术中出血量大于1000 ml 是 PD 术后发生并发症的独立危险因素，术中精细操作，尽量减少出血是防止PD术后发生并发症的关键因素。
목적：분석영향이십이지장절제（PD）술후발생병발증적위험인소。방법대중산대학부속제일의원2000년1월지2009년12월시행PD수술적339례환자적림상자료진행회고성분석，근거술후시부발생병발증분성위병발증조（n＝112）화무병발증조（n＝227）。대가능인기병발증적인소진행단인소화다인소통계분석。결과112례발생병발증（33.0%）。술후병발증포괄：이루29례（8.6%），상소화도출혈24례（7.1%），복강감염20례（5.9%），상구감염21례（6.2%），흉강적액5례（1.5%），격하적액4례（1.2%），폐부감염4례（1.2%），담루4례（1.2%），복강출혈4례（1.2%），위배공장애4례（1.2%），호흡쇠갈1례（0.3%），림파루1례（0.3%），장도진균감염1례（0.3%），심공능불전2례（0.6%），농독혈증1례（0.3%），장경조1례（0.3%）。경단인소분석표명량조환자술중출혈량＞1000 ml화술중수혈장＞1000 ml존재통계학차이（P＜0.05﹚。대이상인소진행다자변량Logistic회귀분석，현시술중출혈량＞1000 ml시PD술후발생병발증적독립위험인소（P＝0.024，OR＝2.265，95%CI：1.113～4.608）。결론수술중출혈량대우1000 ml 시 PD 술후발생병발증적독립위험인소，술중정세조작，진량감소출혈시방지PD술후발생병발증적관건인소。
Objective To investigate the risk factors of postoperative complications in patients undergoing pancreaticoduodenectomy(PD). Methods Clinical data of 339 patients undergoing PD in our hospital from January 2000 to December 2009 were collected and analyzed retrospectively. Possible risk factors in respect to the surgical complications were identified using univariate and multivariate analysis. Results The overall complication rate was 33.0%(112/339) .The postoperative complications of PD included pancreatic leakage in 29 cases (8.6%), upper gastrointestinal hemorrhage in 24 (7.1%), abdominal infection in 20(5.9%), wound infection in 21(6.2%), pleural effusion in 5(1.5%), subphrenic collection in 4(1.2%), pulmonary infection in 4(1.2%), biliary leakage in 4(1.2%), intra-abdominal hemorrhage in 4(1.2%), delayed gastric empty in 4 (1.2%), respiratory failure in 1(0.3%), lymphatic leakage in 1(0.3%), intestinal tract fungal infection in 1(0.3%), cardiac insufficiency in 2(0.6%), septicemia in 1(0.3%), intestinal obstruction in 1(0.3%). The univariate analysis revealed that intraoperative blood loss over 1000 ml and plasma transfusion over 1000 ml were significantly associated with postoperative complications after PD. The multiple logistic analysis revealed that intraoperative blood loss over 1000 ml (P=0.036, OR=4.822, 95%CI:1.11-20.92) was the independent risk factor associated with postoperative complications in patients undergoing PD. Conclusions Intraoperative blood loss over 1000 ml was the independent risk factor of postoperative complications in patients undergoing PD. Improving operative skills and reducing blood loss during operation are critical important to prevent occurrence of complications following PD.