目的    研究胰腺术后主要并发症对住院医疗费用的影响。方法    回顾性分析复旦大学附属中山医院普外科胰腺肿瘤专业组2005年8月至2009年8月341例行胰腺切除术后病人的临床资料和各项住院费用。统计胰腺切除术后围手术期主要并发症（胰瘘、胆瘘、出血、胃排空延迟）的发生率和严重程度。以中华医学会外科学分会胰腺外科学组颁布的胰腺术后并发症定义和分级进行评估。分析围手术期主要并发症及其等级与住院费用之间的关系。结果    341例病人中，156例（45.7%）发生不同程度的胰瘘、15例（4.4%）发生胆瘘、35例（10.3%）发生胃排空延迟、17例（5.0%）发生出血并发症。未发生胰瘘病人的平均住院费用38 224元（人民币，下同），随着胰瘘级别的逐渐升高，住院费用逐渐增加，C级胰瘘病人的平均住院费用为103 293元，其中药品费用、ICU费用、住院床位费用增加最明显。不同胰瘘级别的住院费用之间差异具统计学意义，胰瘘级别与住院费用的增长呈正线性相关（P<0.05）。无胆瘘病人的住院费用为38 758元，而发生胆瘘病人为53 206元，二者差异无统计学意义；无胃排空延迟病人的住院费用为37 992元，而发生胃排空延迟病人为51 857元，以药品费用和住院床位费用的增加最明显，二者之间的差异具有统计学意义（P<0.05）。 结论    胰腺切除术后发生并发症（尤其是胰瘘）增加了病人的住院费用。胰瘘级别与住院费用的增加呈正线性相关。

Clinical and economic analysis of perioperative complication after pancreatectomy        SHI Chen-ye, XU Xue-feng, WANG Dan-song, et al. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author：LOU Wen-hui，E-mail: wenhuilou@yahoo.com.cn
Abstract    Objective    To analyze the relationship of the pancreatic complications after pancreatectomy with in-hospital costs. Methods    The retrospective data were collected in a consecutive series of 341 patients undergoing pacreaticoduodenectomy or distal pancreatectomy from August 2005 to August 2009 in Department of General Surgery, Zhongshan Hospital of Fudan University. The incidence and severity of the perioperative complications including pancreatic fistula, bile fistula, bleeding, delayed gastric emptying (DGE) and so on were analyzed. Meanwhile, the relationship of the pancreatic complications after pancreatectomy with in-hospital costs was analyzed. Results    Among 341 patients, pancreatic fistula was observed in 156 patients (45.7%)；bile fistula was documented in 15 patients (4.4%)；delayed gastric emptying in 35 patients (10.3%)；bleeding in 17 patients (5.0%). The average in-hospital cost of the patients who did not develop pancreatic fistula was RMB 38 224 yuan, while the cost of those with grade C pancreatic fistula was RMB 103 293 yuan. The average in-hospital cost of the patients who did not develop bile fistula was RMB 38 758 yuan, while the cost of those with bile fistula was RMB 53 206 yuan. The average hospitalization cost of the patients who did not develop delayed gastric emptying (DGE) was RMB 37 992 yuan, while the cost of those with DGE was RMB 51 857 yuan. Both pancreatic fistula and DGE were closely related with in-hospital costs; the higher the grade, the more the in-hospital costs (P<0.05). Conclusion    The severity of the perioperative complication such as pancreatic fistula is the important reason of the high medical cost. Higher the grade, the longer the in-hospital stay and the more the medical cost.