中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2013年
1期
1-4
,共4页
张大方%朱卫华%李澍%郑晟旻%彭吉润%朱继业%冷希圣
張大方%硃衛華%李澍%鄭晟旻%彭吉潤%硃繼業%冷希聖
장대방%주위화%리주%정성민%팽길윤%주계업%랭희골
胰十二指肠切除术%胃排空%危险因素
胰十二指腸切除術%胃排空%危險因素
이십이지장절제술%위배공%위험인소
Pancreaticoduodenectomy%Gastric emptying%Risk factors
目的 探讨胰十二指肠切除术后胃排空延迟(delayed gastric emptying,DGE)发生的危险因素.方法 回顾性分析1996年1月至2011年12月213例胰十二指肠切除术的临床资料,分析影响DGE发生的危险因素.结果 213例胰十二指肠切除术共出现DGE 87例,总发生率为40.8％,其中A级30例(14.1％),B级31例(14.5％),C级26例(12.2％).无DGE组、A级DGE组、B级DGE组和C级DGE组的中位术后住院时间分别为21、30.5、32和61 d(x2 =66.171,P=0.000).单因素分析显示手术时间(≥420 min)、术中出血量(≥1000 ml)、Child法消化道重建和术后胰瘘是PD术后DGE的危险因素.Logistic回归分析显示Child法消化道重建、术中出血量(≥1000 ml)和术后胰瘘为术后DGE的独立危险因素,OR值分别为2.098、2.525和4.821.术后胰瘘是C级DGE惟一的危险因素.结论 胰十二指肠切除术后DGE的发生率较高,会明显延长患者住院时间；术中采用Roux-en-Y术式,并尽量减少出血量,有助于减少DGE的发生；术后胰瘘会造成DGE尤其是C级DGE的发生率明显增加.
目的 探討胰十二指腸切除術後胃排空延遲(delayed gastric emptying,DGE)髮生的危險因素.方法 迴顧性分析1996年1月至2011年12月213例胰十二指腸切除術的臨床資料,分析影響DGE髮生的危險因素.結果 213例胰十二指腸切除術共齣現DGE 87例,總髮生率為40.8％,其中A級30例(14.1％),B級31例(14.5％),C級26例(12.2％).無DGE組、A級DGE組、B級DGE組和C級DGE組的中位術後住院時間分彆為21、30.5、32和61 d(x2 =66.171,P=0.000).單因素分析顯示手術時間(≥420 min)、術中齣血量(≥1000 ml)、Child法消化道重建和術後胰瘺是PD術後DGE的危險因素.Logistic迴歸分析顯示Child法消化道重建、術中齣血量(≥1000 ml)和術後胰瘺為術後DGE的獨立危險因素,OR值分彆為2.098、2.525和4.821.術後胰瘺是C級DGE惟一的危險因素.結論 胰十二指腸切除術後DGE的髮生率較高,會明顯延長患者住院時間；術中採用Roux-en-Y術式,併儘量減少齣血量,有助于減少DGE的髮生；術後胰瘺會造成DGE尤其是C級DGE的髮生率明顯增加.
목적 탐토이십이지장절제술후위배공연지(delayed gastric emptying,DGE)발생적위험인소.방법 회고성분석1996년1월지2011년12월213례이십이지장절제술적림상자료,분석영향DGE발생적위험인소.결과 213례이십이지장절제술공출현DGE 87례,총발생솔위40.8％,기중A급30례(14.1％),B급31례(14.5％),C급26례(12.2％).무DGE조、A급DGE조、B급DGE조화C급DGE조적중위술후주원시간분별위21、30.5、32화61 d(x2 =66.171,P=0.000).단인소분석현시수술시간(≥420 min)、술중출혈량(≥1000 ml)、Child법소화도중건화술후이루시PD술후DGE적위험인소.Logistic회귀분석현시Child법소화도중건、술중출혈량(≥1000 ml)화술후이루위술후DGE적독립위험인소,OR치분별위2.098、2.525화4.821.술후이루시C급DGE유일적위험인소.결론 이십이지장절제술후DGE적발생솔교고,회명현연장환자주원시간；술중채용Roux-en-Y술식,병진량감소출혈량,유조우감소DGE적발생；술후이루회조성DGE우기시C급DGE적발생솔명현증가.
Objective To analyze the risk factors for delayed gastric emptying (DGE) after pancreaticoduodenectomy.Methods Clinical data of 213 patients who underwent pancreaticoduodenectomy at our hospital from January 1996 to December 2011 was retrospectively analyzed.Results The overall incidence of DGE was 40.8％ (87/213).The incidence of grade A,grade B and grade C DGE was 14.1％ (30/213),14.5 ％ (31/213) and 12.2％ (31/213) respectively.Median postoperative hospital stay was significantly prolonged in patients with DGE:30.5,32 and 61 days for grade A,B and C respectively versus 21 days in patients without DGE (x2 =66.171,P =0.000).Univariate analysis showed that operation time (≥420 min),intraoperative blood loss (≥ 1000 ml),Child alimentary reconstruction and pancreatic fistula were risk factors for postoperative DGE.Multivariate analysis using Logistic regression identified three variables as independent risk factors associated with postoperative DGE,namely,Child alimentary reconstruction (OR =2.098),intraoperative blood loss (≥ 1000 ml) (OR =2.525) and pancreatic fistula (OR =4.821).Grade C DGE was more frequently seen in patients suffering from postoperative pancreatic fistula.Conclusions The incidence of DGE after pancreaticoduodenectomy is still high.DGE prolongs the postoperative hospital stay significantly.The incidence of DGE could be reduced by Roux-en-Y reconstruction and reducing intraoperative blood loss.Postoperative pancreatic fistula is significantly associated with DGE,especially grade C DGE.
