分析单中心胰十二指肠切除术（PD）围手术期疗效20年变化。

回顾性分析1994年1月至2013年12月中山大学孙逸仙纪念医院行PD且有完整病历资料的523例患者临床资料。根据手术实施的年代将患者分为后10年组和前10年组。后10年组396例，其中男246例，女150例，年龄19～97岁，中位年龄58岁；前10年组127例，其中男69例，女58例，年龄6～79岁，中位年龄56岁。患者均签署知情同意书，符合医学伦理学规定。比较并分析两组患者围手术期情况。两组围手术期情况比较采用秩和检验，率的比较采用χ²检验。

后10年组中位手术时间340（187～920）min明显长于前10年组的310 （180～730）min （Z=3.12，P<0.05），术中出血量300（50～4 500）ml明显少于前10年组的600（200～18 000）ml（Z=-7.62，P<0.05），术后住院时间23（5～148）d明显短于前10年组的25（11～309）d（Z=-2.82，P<0.05），围手术期死亡率6%（24/396）明显低于前10年组的12%（15/127） （χ²=4.61，P<0.05）。后10年组术后并发症发生率、术后并发症患者二次手术率分别为39%（156/396）、29%（45/156），前10年组相应为46%（58/127）、16%（9/58），后10年组的二次手术率明显高于前10年组（χ²=3.98，P<0.05）。二次手术最常见原因为腹腔出血。

随着术中失血量的降低、术后住院时间的缩短和围手术期死亡率的降低，PD已成为一种安全有效的术式。术后发生严重并发症时，及时行二次手术可能对降低围手术期死亡率有重要意义。

To analyze the perioperative curative effect of pancreaticoduodenectomy (PD) in a single center over two decades.

Clinical data of 523 patients who had complete medical record and underwent PD in Sun Yat-sen Memorial Hospital, Sun Yat-sen University between January 1994 and December 2013 were retrospectively analyzed. The patients were divided into the latter decade group and the former decade group according to the year when surgery was performed. Among the 396 patients in the latter decade group, 246 were males and 150 were females with the age ranging from 19 to 97 years old and the median of 58 years old. Among the 127 patients in the former decade group, 69 were males and 58 were females with the age ranging from 6 to 79 years old and the median of 56 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The perioperative conditions of two groups were compared and analyzed using rank sum test and the comparison of rate was conducted using Chi-square test.

The median length of surgery in the latter decade group was 340(187-920) min, significantly longer than 310(180-730) min in the former decade group (Z=3.12, P<0.05). The intraoperative blood loss in the latter decade group was 300(50-4 500) ml, significantly less than 600(200-18 000) ml in the former decade group (Z=-7.62, P<0.05). The postoperative length of stay in the latter decade group was 23(5-148) d, significantly shorter than 25(11-309) d in the former decade group (Z=-2.82, P<0.05). The perioperative mortality in the latter decade group was 6% (24/396), significantly lower than 12%(15/127) in the former decade group (χ²=4.61, P<0.05). The incidence of postoperative complications and the reoperation rate of the patients with postoperative complications in the latter decade group were respectively 39% (156/396) and 29%(45/156), while those in the former decade group were respectively 46% (58/127) and 16% (9/58). The reoperation rate in the latter decade group was significantly higher than that in the former decade group (χ²=3.98, P<0.05). The most common reason for reoperation was intra-abdominal hemorrhage.

PD has become a safe and effective operation as the intraoperative blood loss, the postoperative length of stay and the perioperative mortality decrease. Timely reoperation may has an important significance in reducing the perioperative mortality when severe postoperative complications happen.