Risk factors and treatment strategy for postoperative complications after pancreaticoduodenectomy

doi:10.3877/cma.j.issn.1674-0793.2016.04.011

Abstract

Abstract:

Objective

To explore the risk factors of postoperative complications of pancreaticoduodenectomy (PD) and relative treatment strategies.

Methods

Clinical data of one hundred and forty-eight patients undergoing PD surgery were reviewed between January 2014 and November 2015. The incidence of postoperative complications was recorded and the relative risk factors were analyzed by Logistic method.

Results

The rate of postoperative complications within a month was 33.8% (50/148), 4 cases (2.7%) died. Univariate analysis showed that: (1) jaundice duration, serum total bilirubin level, operation time and prothrombin time were independent risk factors affecting postoperative hemorrhage; (2) jaundice duration, hemoglobin level and intraoperative blood loss were independent risk factors affecting postoperative pancreatic fistula; (3) hemoglobin and common bile duct diameter were independent risk factors of postoperative biliary fistula; (4) age and the operation time were independent risk factors of postoperative pulmonary infection; (5) postoperative bleeding, postoperative pancreatic fistula and operation time were independent risk factors of postoperative abdominal infection; (6) jaundice duration and diabetes were independent risk factors affecting postoperative gastric emptying dysfunction; all these differences were statistically significant (P<0.05). Logistic multiple regression analysis showed that the level of total bilirubin, jaundice duration, blood loss during operation and operation time were the main risk factors of PD, and the difference was statistically significant (P<0.05).

Conclusions

The level of total bilirubin, jaundice duration, blood loss during operation and operation time are the main risk factors that affect the prognosis of PD surgery. It is important to standardize PD operation and strengthen perioperative clinical intervention to prevent the occurrence of postoperative complications of PD.

Key words: Pancreaticoduodenectomy, Postoperative complications, Risk factors, Factor analysis, statistical

Jie Yang, Bin Wang. Risk factors and treatment strategy for postoperative complications after pancreaticoduodenectomy[J]. Chinese Archives of General Surgery(Electronic Edition), 2016, 10(04): 278-282.

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Figures/Tables 7

References 20

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因素		例数	术后出血	无术后出血	χ²值	P值
性别		?	?	?	0.151	0.697
?	男	110	10(9.09)	100(90.91)	?	?
?	女	38	6(15.79)	32(84.21)	?	?
年龄（岁）		?	?	?	1.215	0.304
?	≥ 65	120	10(8.33)	110(91.67)	?	?
?	<65	28	6(21.43)	22(78.57)	?	?
黄疸持续时间(d)		?	?	?	8.846	0.002
?	≥ 21	38	12(31.58)	26(68.42)	?	?
?	<21	110	4(3.64)	106(96.36)	?	?
手术方式		?	?	?	0.012	0.975
?	捆绑式	28	4(14.29)	24(85.71)	?	?
?	套入式	120	12(10.00)	108(90.00)	?	?
血总胆红素(μmol/L)		?	?	?	4.628	0.029
?	≥ 171	80	14(17.50)	66(82.50)	?	?
?	<171	68	2(2.94)	66(97.06)	?	?
血红蛋白(g/L)		?	?	?	0.098	0.682
?	≥ 110	126	12(9.52)	114(90.48)	?	?
?	<110	22	4(18.18)	18(81.82)	?	?
白蛋白(g/L)		?	?	?	0.043	0.785
?	≥ 35	106	10(9.43)	96(90.57)	?	?
?	<35	42	6(14.29)	36(85.71)	?	?
手术时间(h)		?	?	?	5.374	0.018
?	≥7	76	14(18.42)	62(81.58)	?	?
?	<7	72	2(2.78)	70(97.22)	?	?
术中失血量(ml)		?	?	?	0.052	0.904
?	≥ 1 000	32	2(6.25)	30(93.75)	?	?
?	<1 000	116	14(12.07)	102(87.93)	?	?
凝血酶原时间(s)		?	?	?	4.154	0.037
?	异常（延迟=3）	86	14(16.28)	72(83.72)	?	?
?	正常	62	2(3.23)	60(96.77)	?	?

因素		例数	术后出血	无术后出血	χ²值	P值
性别		?	?	?	0.151	0.697
?	男	110	10(9.09)	100(90.91)	?	?
?	女	38	6(15.79)	32(84.21)	?	?
年龄（岁）		?	?	?	1.215	0.304
?	≥ 65	120	10(8.33)	110(91.67)	?	?
?	<65	28	6(21.43)	22(78.57)	?	?
黄疸持续时间(d)		?	?	?	8.846	0.002
?	≥ 21	38	12(31.58)	26(68.42)	?	?
?	<21	110	4(3.64)	106(96.36)	?	?
手术方式		?	?	?	0.012	0.975
?	捆绑式	28	4(14.29)	24(85.71)	?	?
?	套入式	120	12(10.00)	108(90.00)	?	?
血总胆红素(μmol/L)		?	?	?	4.628	0.029
?	≥ 171	80	14(17.50)	66(82.50)	?	?
?	<171	68	2(2.94)	66(97.06)	?	?
血红蛋白(g/L)		?	?	?	0.098	0.682
?	≥ 110	126	12(9.52)	114(90.48)	?	?
?	<110	22	4(18.18)	18(81.82)	?	?
白蛋白(g/L)		?	?	?	0.043	0.785
?	≥ 35	106	10(9.43)	96(90.57)	?	?
?	<35	42	6(14.29)	36(85.71)	?	?
手术时间(h)		?	?	?	5.374	0.018
?	≥7	76	14(18.42)	62(81.58)	?	?
?	<7	72	2(2.78)	70(97.22)	?	?
术中失血量(ml)		?	?	?	0.052	0.904
?	≥ 1 000	32	2(6.25)	30(93.75)	?	?
?	<1 000	116	14(12.07)	102(87.93)	?	?
凝血酶原时间(s)		?	?	?	4.154	0.037
?	异常（延迟=3）	86	14(16.28)	72(83.72)	?	?
?	正常	62	2(3.23)	60(96.77)	?	?

因素		例数	胰瘘	无胰瘘	χ²值	P值
性别		?	?	?	0.004	0.981
?	男	110	18(16.36)	92(83.64)	?	?
?	女	38	6(15.79)	32(84.21)	?	?
年龄（岁）		?	?	?	0.327	0.723
?	≥ 65	120	22(18.33)	98(81.67)	?	?
?	<65	28	2(7.14)	26(92.86)	?	?
黄疸持续时间(d)		?	?	?	6.272	0.016
?	≥ 21	38	14(36.84)	22(63.16)	?	?
?	<21	110	10(9.09)	100(90.91)	?	?
手术方式		?	?	?	0.327	0.683
?	捆绑式	28	22(78.57)	6(21.43)	?	?
?	套入式	120	2(1.67)	118(98.33)	?	?
血总胆红素(μmol/L)		?	?	?	0.135	0.751
?	≥ 171	80	14(17.50)	66(82.50)	?	?
?	<171	68	10(14.71)	58(85.29)	?	?
血红蛋白(g/L)		?	?	?	5.231	0.028
?	≥ 110	126	12(9.52)	114(90.48)	?	?
?	<110	22	12(54.55)	10(45.45)	?	?
白蛋白(g/L)		?	?	?	0.092	0.825
?	≥ 35	106	18(16.98)	88(83.02)	?	?
?	<35	42	6(14.29)	36(85.71)	?	?
手术时间(h)		?	?	?	0.312	0.602
?	≥ 7	76	14(18.42)	62(81.58)	?	?
?	<7	72	10(13.89)	62(86.11)	?	?
术中失血量(ml)		?	?	?	5.024	0.031
?	≥ 1 000	32	12(3.75)	20(96.25)	?	?
?	<1 000	116	12(10.34)	104(89.66)	?	?
胰管直径(mm)		?	?	?	0.714	0.435
?	>3	20	6(30.00)	14(70.00)	?	?
?	≤ 3	128	18(14.06)	110(85.94)	?	?

因素		例数	胰瘘	无胰瘘	χ²值	P值
性别		?	?	?	0.004	0.981
?	男	110	18(16.36)	92(83.64)	?	?
?	女	38	6(15.79)	32(84.21)	?	?
年龄（岁）		?	?	?	0.327	0.723
?	≥ 65	120	22(18.33)	98(81.67)	?	?
?	<65	28	2(7.14)	26(92.86)	?	?
黄疸持续时间(d)		?	?	?	6.272	0.016
?	≥ 21	38	14(36.84)	22(63.16)	?	?
?	<21	110	10(9.09)	100(90.91)	?	?
手术方式		?	?	?	0.327	0.683
?	捆绑式	28	22(78.57)	6(21.43)	?	?
?	套入式	120	2(1.67)	118(98.33)	?	?
血总胆红素(μmol/L)		?	?	?	0.135	0.751
?	≥ 171	80	14(17.50)	66(82.50)	?	?
?	<171	68	10(14.71)	58(85.29)	?	?
血红蛋白(g/L)		?	?	?	5.231	0.028
?	≥ 110	126	12(9.52)	114(90.48)	?	?
?	<110	22	12(54.55)	10(45.45)	?	?
白蛋白(g/L)		?	?	?	0.092	0.825
?	≥ 35	106	18(16.98)	88(83.02)	?	?
?	<35	42	6(14.29)	36(85.71)	?	?
手术时间(h)		?	?	?	0.312	0.602
?	≥ 7	76	14(18.42)	62(81.58)	?	?
?	<7	72	10(13.89)	62(86.11)	?	?
术中失血量(ml)		?	?	?	5.024	0.031
?	≥ 1 000	32	12(3.75)	20(96.25)	?	?
?	<1 000	116	12(10.34)	104(89.66)	?	?
胰管直径(mm)		?	?	?	0.714	0.435
?	>3	20	6(30.00)	14(70.00)	?	?
?	≤ 3	128	18(14.06)	110(85.94)	?	?

因素		例数	胆瘘	无胆瘘	χ²值P值
性别		?	?	?	0.042 0.914 3
?	男	110	10(9.09)	100(90.91)	?
?	女	38	4(10.53)	34(89.47)	?
年龄（岁）		?	?	?	1.521 0.345
?	≥ 65	120	8(6.67)	112(93.33)	?
?	<65	28	6(21.43)	22(78.57)	?
黄疸持续时间(d)		?	?	?	0.436 0.624
?	≥ 21	38	6(15.79)	32(84.21)	?
?	<21	110	8(7.27)	102(92.73)	?
血总胆红素(μmol/L)		?	?	?	0.042 0.915
?	≥ 171	80	8(10.00)	72(90.00)	?
?	<171	68	6(8.82)	62(91.18)	?
血红蛋白(g/L)		?	?	?	5.234 0.030
?	≥ 110	126	8(6.35)	116(93.65)	?
?	<110	22	6(27.27)	16(72.73)	?
白蛋白(g/L)		?	?	?	0.217 0.764
?	≥ 35	106	12(11.32)	94(88.68)	?
?	<35	42	2(4.76)	40(95.24)	?
手术时间(h)		?	?	?	0.317 0.718
?	≥ 7	76	6(7.89)	70(92.11)	?
?	<7	72	8(11.11)	64(88.89)	?
术中失血量(ml)		?	?	?	0.354 0.726
?	≥ 1000	32	4(12.50)	28(87.50)	?
?	<1000	116	10(8.62)	106(91.38)	?
胆管总直径(mm)		?	?	?	4.522 0.029
?	≥ 1.5	52	2(3.85)	50(96.15)	?
?	<1.5	86	12(13.95)	74(86.05)	?

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