37例老年患者胰十二指肠切除术手术风险因素探讨(附6例死亡病例分析)-东南大学学报医学版

37例老年患者胰十二指肠切除术手术风险因素探讨(附6例死亡病例分析)

单位：东南大学附属中大医院普外科,江苏,南京,210009

分类号：R619

出版年·卷·期（页码）：2007·26·第六期（413-416）

摘要：

目的:回顾分析37例老年患者行胰十二指肠切除术围手术期并发症发生及患者的生存情况,探讨可能存在的危险因素.方法:将37例老年(年龄≥65岁)患者按术后有无发生并发症分成两组作对照研究,通过对比两组患者术前合并症、生化指标、血常规指标,寻找对术后预后影响较大的因素,并针对此指标作进一步分析.结果:并发症组术前非外源性输入情况下血浆白蛋白(ALB)水平明显低于无并发症组(P＜0.01),两组术前合并症率有显著性差异(P＜0.01).术前血浆ALB水平＜30 g·L-1共11例,与≥30 g·L-1组(26例)比较,术后并发症发生率无显著性差异(P＞0.05),但术后病死率差异显著(P＜0.01).术前有合并症者共19例,与无合并症组(18例)比较,术后并发症发生率及病死率均无显著差异.结论:术前非外源性输入情况下血浆ALB水平反映了患者的全身营养状况及肝脏储备功能,ALB水平＜30 g·L-1者围手术期病死率明显高于ALB水平≥30 g·L-1者.对于术前伴有合并症的患者,作好完善的术前准备,仍然可以使大部分高龄患者对手术及麻醉具有良好的耐受.

Objective To analyze morbidity and mortality for pancreaticoduodenectomy among 37 senile patients(aged 65 years or older),to find the factors influencing morbidity and mortality.Methods 37 patients aged 65 years or older who underwent pancreaticoduodenectomy were reviewed.15 patients developed complications after surgery and nothing happened the remaining 22 patients.Both groups with respect to preoperative factors affecting morbidity and mortality were compared in the two groups.Results The initial serum albumin levels were lower in patients with complications than that in patients without complications(29.3±5.8 vs 34.8±5.3,P<0.01),while the incidence of preoperative comorbidities was higher in patients with complications.Of 35 patients,11 had serum albumin levels below 30 g·L-1,which had a higher mortality rate as compared with that of 26 patients who had serum albumin levels more than 30 g·L-1(45.5% vs 3.8%,P<0.01).Conclusions The initial blood albumin levels preoperative demonstrated the nutritional status and hepatic reserve function of patients.The morbidity rate in patients with low ALB level was high.With proper selection,careful preoperative preparation,and proper intraoperative conduct of operation,the pancreaticoduodenectomy can be performed safely in senile patients.

参考文献：

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