췌십이지장 절제술 후 합병증과 사망률에 영향을 미치는 인자 분석
Analysis of Factors Influencing Morbidity and Mortality after Pancreaticoduodenectomy
배상호, 채만규, 김태윤, 김성용, 백무준, 이문수, 박상흠, 김현철, 김창호,
소속 상세정보
배상호 ( Bae Sang-Ho )
순천향대학교 천안병원 외과학교실
채만규 ( Chae Man-Kyu )
순천향대학교 의과대학 천안병원 외과학교실
김태윤 ( Kim Tae-Yoon )
순천향대학교 의과대학 천안병원 외과학교실
김성용 ( Kim Sung-Yong )
순천향대학교 의과대학 천안병원 외과학교실
백무준 ( Baek Moo-Jun )
순천향대학교 의과대학 천안병원 외과학교실
이문수 ( Lee Moon-Soo )
순천향대학교 천안병원 외과학교실
박상흠 ( Park Sang-Heum )
순천향대학교 천안병원 소화기내과
김현철 ( Kim Hyung-Chul )
순천향대학교 의과대학 천안병원 외과학교실
김창호 ( Kim Chang-Ho )
순천향대학교 천안병원 외과학교실
KMID : 0371320020620060496
Abstract
Purpose: The surgical morbidity and mortality after a pancreaticoduodenectomy has been decreasing but still remains high. The most serious complications are pancreatic leakage, gastrointestinal or intra-abdominal hemorrhage, and an
intraabdominal
abscess. The less serious complications are delayed gastric emptying and wound problems. The aim of this study was to evaluate the risk factors for morbidity and mortality after a pancreaticoduodenectomy.
Methods: Among 90 patients who underwent pancreaticoduodenectomy from Feb. 1992 to Dec, 2000. 68 patients whose hospital records could be reviewed thoroughly were enrolled in this study. The postoperative morbidity and mortality after a
pancreaticoduodenal resection were evaluated in terms of the patient’s age, combined disease, laboratory values, biliary drainage, transfusion, types of pancreaticojejunostomy, pancreatic duct size, consistency, and the administration of
octreotide.
Univariate and multivariate analysis were performed with a chi-square test and multiple logistic regression test.
Results: Postoperative complications were observed in 43 cases (63.2%). Wound complications were noted in 13 cases (19.1%), gastric emptying disturbance in 10 cases (14.7%), bleeding in 9 cases (13.2%), an abscess in 4 cases (5.9%), and
leakage
in 22 cases (32.4%). Nine cases (13.2%) had died. The causes of death were sepsis due to leakage in 3 cases, bleeding in 3 cases, and others causes in 3 cases. Univariate analysis showed that diabetes mellitus was significantly (P<0.05) related
to
delayed gastric emptying. In multivariate analysis, transfusion was significantly (P<0.05) related to wound infections and mortality. Old age (≥65 years) was significantly related to leakage and delayed gastric emptying.
Conclusions: Pancreaticoduodenectomy is still associated with a high mortality and morbidity rate even though there has been significant progress in the field of pancreatic surgery and postoperative follow-up. Old age and transfusions
appeared to
be the main risk factors for morbidity and mortality after a pancreaticoduodenectomy in this study. In addition to these factors, better anticipation and management of the postoperative complications is essential for improving the surgical
outcome
키워드
췌십이지장 절제술; 합병증; 사망률; Pancreaticoduodenectomy; Morbidity; Mortality;
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