Study On The Operative Security Of Pancreaticoduodenectomy In Senile Patients

Objective The number of periampullary cancer patients in older people isgrowing. Because of the risk of operation in senile patients, Weather the senilepatients should be performed pancreaticoduodenectomy and how to make theoperation more secure is still a problem to surgeons. 115 patients undergonepancreaticoduodenectomy in Tianjin the Third Central Hospital recent years wasinvestigated retrospectively. Analyse the difference of perioperative character andpostoperative complications between senile patients and younger patients. To discussthe security of pancreaticoduodenectomy in senile patients. Use POSSUM scoringsystem to predict the risk of operation and evaluate the value of POSSUM scoringsystem to the assessment of the risk of operation in senile patients.Patients and Methods Data of patients undergone pancreaticoduodenectomyfrom January 2003 to November 2006 was collected. It includes history material,perioperative examination and therapy, postoperative complications etc. All patientswere divided into senile group and younger group by the age of 65 year.preoperative comordities, perioperative treatment and postoperative complicationswas compared between the two groups. Analyse the relation between preoperativecomordities and perioperative therapy and postoperative complications to assess thesecurity of the operation of pancreaticoduodenectomy. Compare the predictivemorbidity and mortality by POSSUM scoring system to the actual morbidity andmortality to evaluate the value of POSSUM scoring system.Results History material showed that hypertension occurred in senile group washigher significantly than younger group. The preoperative examination showed thatcoronary heart disease, hypertension, myocardial ischemia, severe inadequate ofpulmonary function, pulmonary X-ray abnormal, CA19-9 positive, ALB＜30g/1,TBIL＞171umol/l,TBIL＞342umol/l occurred in senile group was higher significantlythan younger group. To compare the perioperative therapy, preoperative bloodpressure control, TPN, postoperative blood pressure control, coronary artery dilationand asthma control occurred in senile patients was higher significantly than youngerpatients. To compare the postoperative complications, the mortality and severe morbidity in two groups has no significant difference, risk Of heart failure, pulmonaryinfection, delayed gastric emptying and psychological disorder in senile group washigher significantly than that in younger group. Risk of heart failure in senile patientswith coronary heart disease was higher significantly than younger group. Morbidityand mortality predicted by POSSUM scoring system has no significant difference tothe actual morbidity and mortality.Conclusion Pancreaticoduodenectomy is suitable to be performed in senilepatients. Sufficient preoperative assessment, excellent operative technique andeffective perioperative therapy is the way to enhance the operative security. POSSUMscoring system can be Used to the assessment of security ofpancreaticoduodenectomy.