POSSUM评分对65岁以上老年人胰十二指肠切除术的意义

目的:探讨POSSUM评分(生理学和手术严重评分结合并发症与病死率系统,physiologicalandoperative-severityscoreforenUmerationofmortalityandmorbidity,POSSUM)对65岁以上老年人行胰十二指肠切除术的术后并发症及病死率的评定意义。方法:对1995年1月至2004年12月间作胰十二指肠切除术的68例(>65岁)胰头和壶腹周围癌患者(老年组)回顾性分析及POSSUM评分,并与同期中青年组(<65岁)128例患者作比较。结果:老年组术后并发症发生率为36.7%,手术病死率11.7%;中青年组分别为20.1%和2.3%。老年组术后并发症主要为肺部感染(14.7%),心律失常(11.7%),急性肾功能不全(5.8%),死亡的主要原因是各种感染所致多脏器衰竭,急性肾功能不全。老年组围手术期POSSUM评分预测术后并发症发生率和手术病死率与实际发生率差异无显著性意义(χ2=0.91,P>0.05)。结论:老年人胰头十二指肠切除术是高风险的手术,围手术期POSSUM评分能预测术后并发症发生率和手术病死率,并指导围手术期处理。

POSSUM Scoring System in Prediction for Pancreaticoduodenectomy in Elderly Patients over 65

Objective:To explore the POSSUM scoring system in prediction of the post-operative complication and the hospital mortality for pancreaticoduodenectomy in the elderly patients over 65 years of age.Methods:A total of 68 patients(>65 years)with the head of pancreas or periampullary carcinomas undergoing Whipple' s procedure from Jan 1995 to Dec 2004 were included for statistical analysis and POSSUM scoring during peri-operative period,and the outcomes were compared between the patients over 65 years(the elderly group)and those under 64(the younger group).Results:The post-operative complication rate of the elderly group was 36.7%,the hospital mortality was 11.7%;the younger group was 20.1% and 2.3%.The post-operative complication of the elderly group was pneumonia,arrhythmia and acute renal failure.The hospital mortality was caused mostly by acute renal failure and multiple organ dysfunction syndrome(MODS).The POSSUM scoring during peri-operative period in the elderly group was correlated with the post-operative complication rate or the hospital mortality.Conclusions:Pancreaticoduodenctomy is of high risk in elderly patients,the POSSUM scoring system can predict the outcome for the elderly patients with the head of pancreas or peri-ampullary carcinomas,and this information can be of benefit to the peri-operative management.