摘要
目的 分析手术台次对胰十二指肠切除术(Whipple手术)术中出血量和早期转归的影响.方法 收集2017至2021年接受Whipple手术的胰腺癌患者519例,男306例,女213例,年龄32～86岁,BMI 15～35 kg/m2,ASA Ⅰ—Ⅲ级.依据手术台次分为两组:台次≤2组和台次＞2组.将患者术中出血量作为主要观察指标,晶体输液量、胶体输液量,术后胰瘘、胆瘘、乳糜瘘、腹部出血、肺部感染、腹腔感染、胃排空障碍、发热等并发症发生率,术后住院时间为次要观察指标.采用Logistic回归分析手术台次与术中大出血和早期转归指标的相关性.结果 共纳入患者519例,其中台次≤2组有415例(80.0％).与台次≤2组比较,台次＞2组术中大出血发生率明显增加(RR=1.669,95％CI 1.146～2.430,P=0.011).两组晶体输液量、胶体输液量、住院期间胰瘘、胆瘘、乳糜瘘、腹部出血、肺部感染、腹腔感染、胃排空障碍、发热等术后并发症发生率和术后住院时间差异无统计学意义.多因素Logistic回归分析示术中大出血的危险因素为手术台次＞2(OR=2.269,95％CI 1.318～3.907,P=0.003)和手术时间延长(OR=1.012,95％CI 1.009～1.016,P＜0.001).结论 手术台次＞2及手术时间延长会增加胰腺癌患者Whipple手术中发生大出血的风险,但对术后住院时间和住院期间术后并发症无明显影响.
Abstract
Objective To retrospectively analyze the effects of sequence of pancreaticoduodenectomy(Whipple surgery)on bleeding in operation and early outcomes.Methods The medical records of 519 pan-creatic cancer patients,305 males and 213 females,aged 32 to 86,BMI 15-35 kg/m2,ASA physical sta-tus Ⅰ-Ⅲ,who underwent Whipple surgery from 2017 to 2021 were collected.According to the sequence of operation,the patients were divided into two groups:group≤2 and group＞2.The primary outcome was hemorrhage during surgery.Secondary outcome was recorded including the crystalloid infusion volume,the colloid infusion volume,incidence of postoperative complications in-hospital consisting of pancreatic fistula,biliary fistula,chylous fistula,abdominal bleeding,pulmonary infection,abdominal infection,gastric emp-tying disorders,fever,and length of postoperative hospital stay.Logistic regression was applied to examine the relations between the sequence of operation and hemorrhage during surgery.Results A total of 519 pa-tients was included in the study.415 patients(80.0％)belonged to the group≤2 and 104 patients be-longed to the group＞2.Compared with the group≤2,the incidence of major bleeding(RR=1.669,95％CI 1.146-2.430,P=0.011)in the group＞2 was higher significantly.There was no significant differ-ence in the crystalloid infusion volume,colloid infusion volume,incidence of postoperative complications in-hospital consisting of pancreatic fistula,biliary fistula,chylous fistula,abdominal bleeding,pulmonary infec-tion,abdominal infection,gastric emptying disorders,fever,and length of postoperative hospital stay between the two groups.Logistic regression identified the sequence of operation＞2(OR=2.269,95％CI 1.318-3.907,P=0.003)and the longer surgery time(OR=1.012,95％CI 1.009-1.016,P＜0.001)as the risk factors for hemorrhage during operation.Conclusion The sequence of operation＞2 and the longer sur-gery time increase the risk of major bleeding in Whipple surgery for pancreatic cancer,while it has no signifi-cant impact on the length of postoperative hospital stay and postoperative complications in-hospital.
维普
万方数据