Analysis of postoperative complications and risk factors following extended pancreaticoduodenectomy

doi:10.3877/cma.j.issn.1674-0793.2015.01.012

Abstract

Abstract:

Objective

The present study aimed at investigating the complications following extended pancreaticoduodenectomy and analyzing risk factors.

Methods

Clinical data of patients undergoing pancreaticoduodenectomy between November 2004 and November 2014 were collected, and were divided into Standard Group and Extended Group retrospectively. The postoperative complications and risk factors were analyzed by uni-variate and multi-variate logistic analysis.

Results

Three hundred and fifty-eight patients were subjected to pancreaticoduodenectomy, 321 cases in Standard Group and 37 cases in Extended Group. The total morbidity was 41.1% and mortality was 5.0%. The differences of intra-abdominal complications (P = 0.02) and delayed gastric emptying (P = 0.01) were significant between the groups. Multi-variate logistic analysis revealed that age over 65 (P < 0.01), operation time more than 360 min (P = 0.03), pancreatic duct diameter less than 3 mm (P < 0.01), soft texture of remnant pancreas (P < 0.01), extended pancreaticoduodenectomy (P = 0.02) and invagination pancreaticojejunostomy (P = 0.01) were independent risk factors for intra-abdominal complications. And independent risk factors for delayed gastric emptying included extended pancreaticoduodenectomy (P = 0.03), operation time more than 360 min (P < 0.01), soft texture of remnant pancreas (P = 0.02) and pancreatic duct diameter less than 3 mm (P < 0.01).

Conclusion

Extended pancreaticoduodenectomy is the independent risk factor for intra-abdominal complications, while it does not increase the mortality.

Key words: Extend pancreaticoduodenectomy, Intra-abdominal complications, Delayed gastric emptying, Independent risk factors

Jianpeng Cai, Wei Chen, Li Huang, Xiaoyu Yin, Lijian Liang, Kunsong Zhang. Analysis of postoperative complications and risk factors following extended pancreaticoduodenectomy[J]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(01): 44-50.

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References 27

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项目		总例数	常规组(321例)	扩大组(37例)	统计值	P值
性别（男：女）		1.8	2.0	1.0	4.5	0.03^a
平均年龄（岁， ± s）		59.3 ± 12.3	59.1 ± 12.4	61.2 ± 10.9	-1.0	0.35
术前资料		?	?	?	?	?
?	高血压病[例(%)]	65(18.2)	53(16.5)	12(32.4)	5.7	0.02^a
?	糖尿病[例(%)]	35(9.8)	29(9.0)	6(16.2)	1.9	0.23
?	冠心病[例(%)]	10(2.8)	9(2.8)	1(2.7)	< 0.01	0.97
?	白蛋白(g/L， ± s）	38.8 ± 5.0	38.9 ± 4.9	37.9 ± 5.5	0.9	0.41
?	胆红素（μmol/L， ± s）	111.2 ± 95.2	110.6 ± 96.3	116.1 ± 85.8	-0.9	0.46
?	胆管引流[例(%)]	101(28.3)	91(28.3)	10(27.0)	< 0.05	0.86
术中资料		?	?	?	?	?
?	手术时间(min， ± s）	368.8 ± 105.9	362.6 ± 104.7	422.4 ± 101.7	-3.3	< 0.01^a
?	中位术中出血量(ml)^b	600.0	500.0	900.0	-2.4	0.02^a
?	术中输血(U) ^b	6	5	8	-2.8	0.01^a
胰管直径[例(%)]		?	?	?	1.2	0.27
?	< 3 mm	166(46.4)	152(47.4)	14(37.8)	?	?
?	≥3 mm	192(53.6)	169(52.6)	23(62.2)	?	?
胰腺质地[例(%)]		?	?	?	0.5	0.49
?	质软	203(56.7)	184(57.3)	19(51.4)	?	?
?	质硬	155(43.3)	137(42.7)	81(48.6)	?	?
吻合方式[例(%)]		?	?	?	< 0.01	1.00
?	套入式	300(83.8)	269(83.8)	31(83.8)	?	?
?	胰管空肠式	58(16.8)	52(16.2)	6(16.2)	?	?
术后资料		?	?	?	?	?
?	使用生长抑素[例(%)]	210(58.7)	184(57.3)	26(70.3)	2.3	0.13
?	术后住院天数(d， ± s）	23.3 ± 18.5	23.6 ± 19.2	20.9 ± 10.5	0.2	0.90
病理[例(%)]		?	?	?	26.5	< 0.01 ^a
?	壶腹癌	134(37.4)	131(40.8)	3(8.1)	?	?
?	胰腺肿瘤	114(31.9)	94(29.3)	20(54.1)	?	?
?	十二指肠癌	40(11.2)	35(10.9)	5(13.5)	?	?
?	胆管癌	37(10.3)	35(10.9)	2(5.4)	?	?
?	其他恶性肿瘤	10(2.8)	7(2.2)	3(8.1)	?	?
?	慢性胰腺炎	9(2.5)	6(1.9)	3(8.1)	?	?
?	其他良性肿物	14(3.9)	13(4.0)	1(2.7)	?	?
经皮置管引流[例(%)]		61(17.0)	55(17.1)	6(16.2)	0.02	0.89
再次手术[例(%)]		24(6.7)	22(6.9)	2(5.4)	0.1	0.74
并发症发生率[例(%)]		147(41.1)	127(39.6)	20(54.1)	2.9	0.09
死亡率[例(%)]		18(5.0)	15(4.7)	3(8.1)	0.82	0.42

项目		总例数	常规组(321例)	扩大组(37例)	统计值	P值
性别（男：女）		1.8	2.0	1.0	4.5	0.03^a
平均年龄（岁， ± s）		59.3 ± 12.3	59.1 ± 12.4	61.2 ± 10.9	-1.0	0.35
术前资料		?	?	?	?	?
?	高血压病[例(%)]	65(18.2)	53(16.5)	12(32.4)	5.7	0.02^a
?	糖尿病[例(%)]	35(9.8)	29(9.0)	6(16.2)	1.9	0.23
?	冠心病[例(%)]	10(2.8)	9(2.8)	1(2.7)	< 0.01	0.97
?	白蛋白(g/L， ± s）	38.8 ± 5.0	38.9 ± 4.9	37.9 ± 5.5	0.9	0.41
?	胆红素（μmol/L， ± s）	111.2 ± 95.2	110.6 ± 96.3	116.1 ± 85.8	-0.9	0.46
?	胆管引流[例(%)]	101(28.3)	91(28.3)	10(27.0)	< 0.05	0.86
术中资料		?	?	?	?	?
?	手术时间(min， ± s）	368.8 ± 105.9	362.6 ± 104.7	422.4 ± 101.7	-3.3	< 0.01^a
?	中位术中出血量(ml)^b	600.0	500.0	900.0	-2.4	0.02^a
?	术中输血(U) ^b	6	5	8	-2.8	0.01^a
胰管直径[例(%)]		?	?	?	1.2	0.27
?	< 3 mm	166(46.4)	152(47.4)	14(37.8)	?	?
?	≥3 mm	192(53.6)	169(52.6)	23(62.2)	?	?
胰腺质地[例(%)]		?	?	?	0.5	0.49
?	质软	203(56.7)	184(57.3)	19(51.4)	?	?
?	质硬	155(43.3)	137(42.7)	81(48.6)	?	?
吻合方式[例(%)]		?	?	?	< 0.01	1.00
?	套入式	300(83.8)	269(83.8)	31(83.8)	?	?
?	胰管空肠式	58(16.8)	52(16.2)	6(16.2)	?	?
术后资料		?	?	?	?	?
?	使用生长抑素[例(%)]	210(58.7)	184(57.3)	26(70.3)	2.3	0.13
?	术后住院天数(d， ± s）	23.3 ± 18.5	23.6 ± 19.2	20.9 ± 10.5	0.2	0.90
病理[例(%)]		?	?	?	26.5	< 0.01 ^a
?	壶腹癌	134(37.4)	131(40.8)	3(8.1)	?	?
?	胰腺肿瘤	114(31.9)	94(29.3)	20(54.1)	?	?
?	十二指肠癌	40(11.2)	35(10.9)	5(13.5)	?	?
?	胆管癌	37(10.3)	35(10.9)	2(5.4)	?	?
?	其他恶性肿瘤	10(2.8)	7(2.2)	3(8.1)	?	?
?	慢性胰腺炎	9(2.5)	6(1.9)	3(8.1)	?	?
?	其他良性肿物	14(3.9)	13(4.0)	1(2.7)	?	?
经皮置管引流[例(%)]		61(17.0)	55(17.1)	6(16.2)	0.02	0.89
再次手术[例(%)]		24(6.7)	22(6.9)	2(5.4)	0.1	0.74
并发症发生率[例(%)]		147(41.1)	127(39.6)	20(54.1)	2.9	0.09
死亡率[例(%)]		18(5.0)	15(4.7)	3(8.1)	0.82	0.42

并发症		总例数(358例)	常规组(321例)	扩大组(37例)	P值
腹腔内并发症		120(33.5)	101(31.5)	19(51.4)	0.02^a
?	胃排空功能障碍	56(15.6)	45(14.0)	11(29.7)	0.01^a
?	腹腔感染	48(13.4)	41(12.8)	7(18.9)	0.31
?	术后胰漏	41(11.5)	38(11.8)	3(8.1)	0.78
?	术后出血	35(9.8)	31(9.7)	4(10.8)	0.77
?	胆漏	10(2.8)	10(3.1)	0(0)	-
腹腔外并发症		38(10.67)	18(9.38)	20(12.20)	0.30
?	肺部感染	9(2.5)	7(2.2)	2(5.4)	0.24
?	胸腔积液	9(2.5)	8(2.5)	1(2.7)	1.00
?	切口感染	17(4.7)	17(5.3)	0(0)	-

并发症		总例数(358例)	常规组(321例)	扩大组(37例)	P值
腹腔内并发症		120(33.5)	101(31.5)	19(51.4)	0.02^a
?	胃排空功能障碍	56(15.6)	45(14.0)	11(29.7)	0.01^a
?	腹腔感染	48(13.4)	41(12.8)	7(18.9)	0.31
?	术后胰漏	41(11.5)	38(11.8)	3(8.1)	0.78
?	术后出血	35(9.8)	31(9.7)	4(10.8)	0.77
?	胆漏	10(2.8)	10(3.1)	0(0)	-
腹腔外并发症		38(10.67)	18(9.38)	20(12.20)	0.30
?	肺部感染	9(2.5)	7(2.2)	2(5.4)	0.24
?	胸腔积液	9(2.5)	8(2.5)	1(2.7)	1.00
?	切口感染	17(4.7)	17(5.3)	0(0)	-

因素		IACs			EACs
		单因素分析	多因素分析		单因素分析	多因素分析
		P值	P值	OR(95% CI)	P值	P值	OR(95% CI)
男性		0.56	?	?	0.32	?	?
年龄≥65岁		0.04	< 0.01 ^a	2.4(1.4 ~ 4.1)	0.32	?	?
术前资料		?	?	?	?	?	?
?	高血压病	0.20	?	?	0.08	?	?
?	糖尿病	0.41	?	?	0.51	?	?
?	冠心病	0.27	?	?	0.92	?	?
?	白蛋白< 35 g/L	0.02	0.06	1.8(0.9 ~ 3.4)	0.03	0.06	2.1(0.9 ~ 4.6)
?	黄疸	0.25	?	?	0.33	?	?
?	胆管引流	0.09	?	?	0.27	?	?
术中资料		?	?	?	?	?	?
?	手术时间≥360 min	0.008	0.03 ^a	1.7(1.1 ~ 2.9)	0.26	?	?
?	术中出血≥600 ml	0.009	0.51	1.2(0.7 ~ 2.2)	0.85	?	?
?	术中输血≥6 U	0.02	0.16	1.5(0.9 ~ 2.5)	0.14	?	?
?	胰管直径< 3 mm	< 0.01	< 0.01 ^a	3.0(1.8 ~ 5.1)	0.10	?	?
?	胰腺质软	< 0.01	< 0.01 ^a	2.6(1.5 ~ 4.5)	0.10	?	?
?	扩大切除	0.02	0.02 ^a	2.5(1.1 ~ 5.5)	0.56	?	?
?	套入式吻合	0.002	0.01 ^a	3.2(1.4 ~ 7.5)	0.32	?	?
?	胰管支架管	0.08	?	?	0.26	?	?
术后资料		?	?	?	?	?	?
?	生长抑素	0.10	?	?	0.94	?	?
?	病理	0.39	?	?	0.20	?	?

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