摘要目的 探讨腹腔镜胰十二指肠切除术(LPD)术后并发症的Clavien-Dindo分级情况及影响因素.方法 采用回顾性队列研究方法.收集2016年6月至2017年6月华中科技大学同济医学院附属同济医院胆胰外科收治的行LPD治疗的124例患者的临床资料.男性64例(51.6％),女性60例(48.4％);年龄(57.4±9.2)岁(范围:23～ 82岁).术前均诊断为壶腹部周围肿瘤,术后病理学检查结果提示为恶性肿瘤.通过Clavien-Dindo分级法统计术后并发症发生情况,通过单因素分析和多因素Logistic回归分析并发症发生的影响因素.结果 124例患者中,发生术后并发症30例(24.2％),Clavien-Dindo分级结果显示:Ⅰ级4例(3.2％),Ⅱ级18例(14.5％),Ⅲa级6例(4.8％),Ⅳb级1例(0.1％),Ⅴ级1例(0.1％).并发症发生情况:术后出血8例,胰瘘10例(生化漏7例、B级胰瘘3例),胆瘘1例,胃肠道瘘1例,腹腔感染10例,肝功能衰竭1例,肾功能衰竭1例,心律失常2例,死亡1例.5例患者发生多种并发症.单因素分析结果显示,术后并发症与体重指数、美国麻醉师协会分级(ASA)、术中输血、胰腺质地有关(P值均＜0.05).多因素Logistic回归分析结果显示,ASA分级Ⅲ级、术中输血、胰腺质软是LPD术后发生并发症的独立影响因素(P值均＜0.05).结论 Clavien-Dindo分级可应用于行LPD患者的围手术期管理中,其中ASA评分Ⅲ级及以上、胰腺质地柔软、术中输血是术后并发症发生的影响因素.

abstractsObjective To semi-quantify the postoperative complications occurred after laparoscopic pancreaticoduodenectomy(LPD) using Clavien-Dindo score,thereafter exploring its impact factors.Methods In this retrospective cohort study,the clinical data of 124 patients who had undergone LPD for periampullary tumor from June 2016 to June 2017 at Department of Biliary Pancreatic Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were collected.Malignancy was confirmed based on postoperative pathological reports.Postoperative complications were semi-quantitated using Clavien-Dindo score.Multivariable logistic regression model was applied to explore the factors related to severe complications(Clavien-Dindo Ⅲb-Ⅴ).Results Of the 124 patients,there were 64 males(51.6％) and 60 females(48.4％),with age of 57 years (range,23-82 years).In total,postoperative complications occurred in 30 patients (24.2％).Among the 30 patients,4 patients suffered Clavien-Dindo grade Ⅰ,18 patients (14.5％) suffered Clavien-Dindo grade Ⅱ,6 patients (4.8％) suffered Clavien-Dindo grade Ⅲ a,1 patient(0.1％) suffered Clavien-Dindo grade Ⅳ b,and 1 patient(0.1％) suffered Clavien-Dindo grade Ⅴ.Intraabdominal hemorrhage occurred in 8 patients,pancreatic fistula was found in 10 patients(7 patients had biochemical leakage and 3 of them had grade B pancreatic fistula),both biliary fistula and gastrointestinal fistula were found in 1 patient.Abdominal infection occurred in 10 patients,both liver failure and renal failure occurred in one patient.Moreover,arrhythmia was found in two patients,and mortality occurred in one patient.Five patients suffered multiple complications.Univariable analysis showed that postoperative complications were associated with body mass index,American Society of Anesthesiologists (ASA) score,intraoperative blood transfusion,and pancreatic texture (P＜ 0.05).In multivariable logistic regression,ASA grade Ⅲ,intraoperative blood transfusion,and pancreatic softness were independently related to postoperative complications after LPD (P ＜ 0.05).Conclusions Clavien-Dindo score is feasible to be applied in management of patients with LPD.ASA score,texture of pancreas,and intraoperative blood transfusion were independently associated with postoperative complications.