Hughes Christopher, Hurtuk Michael G, Rychlik Karen, Shoup Margo, Aranha Gerard V
Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA.
J Gastrointest Surg. 2008 Nov;12(11):1822-7; discussion 1827-9. doi: 10.1007/s11605-008-0680-y. Epub 2008 Sep 12.
Previous studies identified an association between dilated pancreatic and biliary ducts and lower rates of pancreatic leak after pancreaticoduodenectomy, but it remains unclear whether elevated liver function tests are also associated with lower rates of complications. The purpose of this study was to determine if preoperative liver function tests are associated with postoperative complications.
We identified 452 patients who received a pancreaticoduodenectomy from 1990-2007. Clinicopathological data was collected for each patient, and regression analyses were performed to identify predictors of postoperative complications.
Of the patients studied, 289 (64%) experienced no postoperative complications. In univariate analysis, patients with a low or normal preoperative aspartate aminotransferase (p = 0.03) or alkaline phosphatase (p = 0.03), had higher rates of complications. Multivariate analysis confirmed an elevated alkaline phosphatase was associated with a lower incidence of complications (OR = 0.56, p = 0.02), while preoperative anemia was found to be a predictor of complications following pancreaticoduodenectomy (OR = 2.01, p = 0.02).
Anemic patients and those with normal liver function tests were more likely to experience complications after pancreaticoduodenectomy. This may represent extent of disease and tumors not causing biliary or pancreatic dilatation, respectively. Precautions, such as intraoperative ductal stents, should be considered when operating on this group of patients to minimize complications.
既往研究发现，胰十二指肠切除术后胰腺和胆管扩张与胰瘘发生率较低相关，但目前尚不清楚肝功能检查结果升高是否也与较低的并发症发生率相关。本研究旨在确定术前肝功能检查是否与术后并发症相关。
我们纳入了1990年至2007年间接受胰十二指肠切除术的452例患者。收集每位患者的临床病理数据，并进行回归分析以确定术后并发症的预测因素。
在研究的患者中，289例（64%）未发生术后并发症。单因素分析显示，术前天冬氨酸转氨酶水平低或正常（p = 0.03）或碱性磷酸酶水平低或正常（p = 0.03）的患者并发症发生率较高。多因素分析证实，碱性磷酸酶升高与较低的并发症发生率相关（OR = 0.56，p = 0.02），而术前贫血是胰十二指肠切除术后并发症的一个预测因素（OR = 2.01，p = 0.02）。
贫血患者和肝功能检查结果正常的患者在胰十二指肠切除术后更易发生并发症。这可能分别代表疾病范围和肿瘤未引起胆管或胰腺扩张。对这类患者进行手术时应考虑采取如术中放置胆管支架等预防措施，以尽量减少并发症。
