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目的探讨对老年病人实施胰十二指肠切除术的可行性,总结降低术后并发症发生率和病死率的经验。方法回顾性分析2002年5月至2007年5月复旦大学附属华东医院普外科行164例胰十二指肠切除术的临床资料,分析老年和非老年病人术前身体状况的评估指标、术后并发症和死亡危险因素。结果老年与非老年病人术前ASA评分及心功能分级差异有统计学意义。老年病人术后院内病死率高于非老年病人,死亡病例多发生在术后30d以后,两组术后并发症发生率的差异无统计学意义。术前低蛋白血症、术中失血>1000mL是术后并发症发生的危险因素。术后院内死亡的危险因素为年龄>70岁、术前低蛋白血症、术前合并冠心病和心功能分级>2。结论老年病人并不是胰十二指肠切除术的绝对禁忌证,术前改善营养状况,加强术后监护及治疗是降低并发症发生率和术后病死率的有效手段。
Objective To explore the feasibility of pancreatoduodenectomy in elderly patients and to summarize the experience of reducing the incidence of postoperative complications and mortality. Methods The clinical data of 164 cases of pancreatoduodenectomy in the General Hospital of Huadong Hospital Affiliated to Fudan University from May 2002 to May 2007 were analyzed retrospectively to evaluate the preoperative physical status of elderly and non-elderly patients. Complications and risk factors for death. Results There were significant differences in preoperative ASA score and cardiac function between elderly and non-elderly patients. The in-hospital mortality rate of elderly patients was higher than that of non-elderly patients. The deaths occurred more than 30 days after operation. There was no significant difference in the incidence of postoperative complications between the two groups. Preoperative hypoproteinemia, intraoperative blood loss> 1000mL is a risk factor for postoperative complications. The risk factors for postoperative in-hospital death were age> 70 years, preoperative hypoproteinemia, preoperative coronary heart disease and cardiac function grade> 2. Conclusion Elderly patients are not an absolute contraindication to pancreatoduodenectomy. Preoperative nutritional status improvement and postoperative care and treatment are effective measures to reduce the incidence of complications and postoperative mortality.