摘要
目的 分析70岁以上老年人胰十二指肠切除术（PD）临床资料并探讨其安全性。方法 回顾性分析老年人行PD的临床资料，将90例50岁以上PD手术病例分成≥70岁（高龄组，n＝27）和＜70岁（低龄组，n＝63）两组，分析两组术前Karnofsky功能状态（KPS）评分、入院时血红蛋白（Hb）、血细胞比容（Hct）、血浆白蛋白（ALB）、血清总胆红素（TBIL）、血浆前白蛋白（PALB）、血糖、血钾、手术时间、术中失血量、术后重症监护病房（ICU）入住率、术后住院日、术后并发症发生率及术后死亡率。结果 高龄组与低龄组比较，术前KPS评分低[（71.11±6.98） vs （85.40±6.43），P＜0.01]、血浆ALB低[（34.86±4.54） vs （37.02±4.13）g/L，P＜0.05]、PALB低（127.36±41.19） vs （160.27±57.11）g/L，P＜0.05）、血糖高[（8.47±3.68） vs （6.41±2.12）mmol/L，P＜0.05]、血钾低[（3.38±0.48） vs （3.81±0.45）mmol/L，P＜0.01]、术后ICU入住率高（81.48% vs 39.68%，P＜0.01），两组间的差异均有统计学意义。两组并发症发生率差异无统计学意义（48.15% vs 39.42%，P＞0.05）。高龄组无住院期间手术死亡，低龄组有2例术后30d内死于并发症。结论 严格掌握适应证，重视术前内环境调整，术后积极ICU治疗，≥70岁高龄患者行PD是安全可行的。
Objective To analyze the clinical data of the elderly undergoing pancreaticoduonectomy （PD） and investigate the safety of the surgery. Methods Clinical data of 90 over 50-year-old patients undergoing PD for pancreatic and periampullary cancer in our department from 2007 to 2011 were collected and retrospectively analyzed. They were divided into two groups according to their age, that is, ≥70-year-old group （n=27） and〈70-year-old group （n=63）. Their indices, including pre-operative Karnofsky Performance Status （KPS）, hemoglobin （Hb）, hematocrit （Hct）, albumin （ALB）, serum total bilirubin （TBIL）, prealbumin （PALB）, blood glucose, serum potassium, operation time, blood loss during operation, rate of postoperative intensive care unit （ICU） stay, duration of postoperative hospital stay, incidence of postoperative complications, and postoperative mortality, were analyzed and compared. Results The ≥70-year-old group had significantly lower KPS score [（71.11±6.98） vs （85.40±6.43）, P=0.00], ALB [（34.86±4.54） vs （37.02±4.13）g/L, P〈0.05], PALB [（127.36±41.19） vs （160.27±57.11）g/L, P〈0.05], and serum potassium [（3.38±0.48） vs （3.81±0.45）mmol/L, P〈0.01], but obviously higher blood glucose [（8.47±3.68） vs （6.41±2.12）mmol/L, P〈0.05], and postoperative rate of ICU stay （81.5% vs 39.68%, P〈0.01） when compared with 〈70-year-old group. The incidence of postoperative complications was higher in ≥70-year-old group than in the other group, though without significant difference （48.15% vs 39.42%, P〉0.05）. No patient died after PD ≥70-year-old, but two patients died due to complications in 〈70-year-old group within 30d after operation. Conclusion It is feasible and safe to perform PD to elderly patients after careful patient selection, physical fitness improvement, and life-supporting treatment after operation.
出处
《中华老年多器官疾病杂志》
2013年第7期519-522,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
