摘要
目的探讨胰十二指肠切除术后发生延迟性消化道出血的危险因素。方法采用回顾性病例对照研究方法。收集2017年11月至2020年5月安徽医科大学第一附属医院收治的173例行胰十二指肠切除术病人的临床病理资料;男107例,女66例;年龄为(61±11)岁。病人均行胰十二指肠切除术,术后消化道出血采用非手术治疗或手术治疗。观察指标:(1)胰十二指肠切除术后消化道出血及治疗情况。(2)胰十二指肠切除术后发生延迟性消化道出血的影响因素分析。正态分布的计量资料以x±s表示,计数资料以绝对数或百分比表示。单因素分析采用χ^(2)检验,多因素分析采用Logistic回归模型。结果(1)胰十二指肠切除术后消化道出血及治疗情况:173例行胰十二指肠切除术病人中,15例术后发生消化道出血,其中2例为早期消化道出血,13例为延迟性消化道出血。13例延迟性消化道出血病人中,3例为轻度出血,10例为重度出血;4例为胃黏膜病变出血,3例为胃溃疡出血,3例为胃肠吻合口出血,2例为胆肠吻合口出血,1例为胆管动静脉瘘出血。13例延迟性消化道出血病人中,4例行内科保守治疗,4例行介入治疗,3例行内镜治疗,2例行手术治疗。13例延迟性消化道出血病人中,12例治愈,1例死亡。(2)胰十二指肠切除术后发生延迟性消化道出血的影响因素分析:单因素分析结果显示胰十二指肠切除术后白蛋白、总胆红素、胰瘘、胃溃疡病史是影响胰十二指肠切除术后发生延迟性消化道出血的相关因素(χ^(2)=7.888、6.555、4.252、6.253,P<0.05)。多因素分析结果显示:总胆红素>200μmol/L、胰瘘、胃溃疡病史是胰十二指肠切除术后发生延迟性消化道出血的独立危险因素(优势比=4.122、4.290、5.267,95%可信区间为1.009~16.844、1.149~16.022、1.195~23.221,P<0.05)。结论总胆红素>200μmol/L、胰瘘、胃溃疡病史是胰十二指肠切除术后发生延迟性消化道出血的独立危险因素。
Objective To investigate the risk factors for delayed gastrointestinal hemorrhage after pancreaticoduodenectomy(PD).Methods The retrospective case-control study was conducted.The clinicopathological data of 173 patients who underwent PD in the First Affiliated Hospital of Anhui Medical University from November 2017 to May 2020 were collected.There were 107 males and 66 females,aged(61±11)years.All patients underwent PD and patients with gastrointestinal hemorrhage after surgery were treated with non-surgical or surgical treatments.Observation indicators:(1)gastrointestinal hemorrhage after PD and treatment situations;(2)influencing factors for delayed gastrointestinal hemorrhage after PD.Measurement data with normal distribution were expressed by Mean±SD,and count data were expressed by absolute numbers or percentages.Univariate analysis was performed using the chi-square test,and multivariate analysis was performed using the Logistic regression model.Results(1)Gastrointestinal hemorrhage after PD and treatment situations:of 173 patients,15 cases had gastrointestinal hemorrhage after PD,including 2 cases with early gastrointestinal hemorrhage and 13 cases with delayed gastrointestinal hemorrhage.Among the 13 cases with delayed gastrointestinal hemorrhage,3 cases were mild hemorrhage,10 cases were severe hemorrhage,4 cases were gastric mucosal hemorrhage,3 cases were gastric ulcer hemorrhage,3 cases were gastrointestinal anastomotic hemorrhage,2 cases were cholangio-jejunal anastomotic hemorrhage,1 case was biliary arteriovenous fistula hemorrhage.Of the 13 patients with delayed gastrointestinal hemorrhage,4 cases were treated only with conservative treatment,4 cases were treated with interventional treatment,3 cases were treated with endoscopic treatment and 2 cases were treated with surgical treatment.Of the 13 patients with delayed gastrointestinal hemorrhage,12 were cured and 1 died.(2)Influencing factors for delayed gastrointestinal hemorrhage after PD:results of univariate analysis showed that albumin,total bilirubin,pancreatic fistula and history of gastric ulcer were the influencing factors for delayed gastrointestinal hemorrhage after PD(χ^(2)=7.888,6.555,4.252,6.253,P<0.05).Results of multivariate analysis showed that total bilirubin>200μmol/L,pancreatic fistula and history of gastric ulcer were independent risk factors for delayed gastrointestinal hemorrhage after PD(odds ratio=4.122,4.290,5.267,95%confidence interval as 1.009-16.844,1.149-16.022,1.195-23.221,P<0.05).Conclusion Total bilirubin>200μmol/L,pancreatic fistula and history of gastric ulcer are independent risk factors for delayed gastrointestinal hemorrhage after PD.
作者
刘磊
刘付宝
谢坤
赵义军
濮天
耿小平
Liu Lei;Liu Fubao;Xie Kun;Zhao Yijun;Pu Tian;Geng Xiaoping(Department of Hepatobiliary and Pancreatic Surgery of High-tech Branch Zone,Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230001,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2021年第4期414-418,共5页
Chinese Journal of Digestive Surgery
基金
安徽省重点研究和开发计划项目(1804h08020239)。
关键词
胰腺肿瘤
胰十二指肠切除术
消化道出血
高胆红素血症
胰瘘
危险因素
Pancreatic neoplasms
Pancreaticoduodenectomy
Gastrointestinal hemo-rrhage
Hyperbilirubinemia
Pancreatic fistula
Risk factors
