Nanashima Atsushi, Abo Takafumi, Nonaka Takashi, Hidaka Shigekazu, Takeshita Hiroaki, Morisaki Tomohito, Uehara Ryohei, Ohnita Ken, Takeshima Fuminao, Isomoto Hajime, Sawai Terumitsu, Nakao Kazuhiko, Nagayasu Takeshi
Department of Surgery, Nagasaki University Hospital, Nagasaki, Japan.
Hepatogastroenterology. 2012 Jun;59(116):1141-6. doi: 10.5754/hge10777.
BACKGROUND/AIMS: Operative indications for pancreatectomy in elderly patients with pancreatic disease remain controversial. We examined clinicopathological characteristics and early outcomes in each generation of 147 patients who underwent pancreatectomy.
Patients were divided into four groups: Group 1 (n=15, 10%), young patients <50 years old; Group 2 (n=65; 44%), patients at 50- 69 years old; Group 3 (n=61, 42%), patients at 70-79 years old and Group 4 (n=6, 4%), elderly patients >80 years old. Clinicopathological and surgical parameters were examined, including estimation of physiological ability and surgical stress consisting of preoperative risk score (PRS), surgical stress score (SSS) and comprehensive risk score (CRS).
Prevalence of co-morbidity and American Society of Anesthesiologists (ASA) score increased significantly with increasing patient age (p<0.05). Extent of pancreatectomy and lymphadenectomy did not differ between groups and surgical records were similar. Tumor stage, postoperative course and complications were similar between groups. PRS and CRS increased significantly with increasing patient age (p<0.05) but SSS did not. Univariate analysis identified presence of systemic comorbidity, ASA score =2 and PRS =0.32 as factors associated with postoperative complications, but no independent predictive parameters were identified on multivariate analysis.
Careful management and adequate decisions regarding pancreatectomy upon identification of co-morbidity, ASA score and PRS are important in elderly patients with pancreatic disease before pancreatectomy.
背景/目的：老年胰腺疾病患者胰腺切除术的手术指征仍存在争议。我们研究了147例行胰腺切除术患者各年龄段的临床病理特征及早期预后。
患者分为四组：第1组（n = 15，10%），年龄<50岁的年轻患者；第2组（n = 65，44%），年龄在50 - 69岁的患者；第3组（n = 61，42%），年龄在70 - 79岁的患者；第4组（n = 6，4%），年龄>80岁的老年患者。研究了临床病理和手术参数，包括生理能力评估以及由术前风险评分（PRS）、手术应激评分（SSS）和综合风险评分（CRS）组成的手术应激。
随着患者年龄增加，合并症患病率和美国麻醉医师协会（ASA）评分显著升高（p<0.05）。各组间胰腺切除术和淋巴结清扫范围无差异，手术记录相似。各组间肿瘤分期、术后病程及并发症相似。PRS和CRS随患者年龄增加显著升高（p<0.05），但SSS无变化。单因素分析确定全身合并症的存在、ASA评分=2和PRS = 0.32为与术后并发症相关的因素，但多因素分析未确定独立的预测参数。
对于老年胰腺疾病患者，在胰腺切除术前，根据合并症、ASA评分和PRS进行仔细管理并做出适当决策很重要。
