IMPROVED HOSPITAL MORBIDITY, MORTALITY, AND SURVIVAL AFTER THE WHIPPLE PROCEDURE
IMPROVED HOSPITAL MORBIDITY, MORTALITY, AND SURVIVAL AFTER THE WHIPPLE PROCEDURE
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DOI：
10.1097/00000658-198709000-00014
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发表时间：
1987-09-01
影响因子：
9
通讯作者：
CAMERON, JL
中科院分区：
文献类型：
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作者：
CRIST, DW;SITZMANN, JV;CAMERON, JL
1969 年至 1986 年间，88 名患者因胰腺腺癌（N = 50）、壶腹部腺癌（N = 19）、远端胆管腺癌（N = 10）和十二指肠腺癌（N = 9）接受了 Whipple 切除术。 49 例患者为男性，39 例为女性，平均年龄为 58 岁（范围：34-84 岁）。根据两个不同时间段将患者分为两组：1969年至1980年接受手术的患者（N = 41）和1981年至1986年接受手术的患者（N = 47）。两组之间在平均年龄、性别分布、出现症状前的持续时间或平均体重减轻方面没有显着差异。同样，两组患者的术前实验室数据相似。此外，两组胰腺癌患者的平均肿瘤大小（3.5 cm vs. 3.2 cm）和非胰腺壶腹周围癌患者（1.9 cm vs. 2.2 cm）相似，阳性淋巴结的发生率也相似。在第一期接受手术的 41 名患者中，医院发病率和死亡率分别为 59% 和 24%。相比之下，近期接受手术的 47 名患者的住院发病率和死亡率分别为 36% 和 2%。最近一段时间，每年进行的 Whipple 手术增多（7.8 例 vs. 3.4 例），而外科医生数量减少（3.4 例手术/外科医生 vs. 1.9 例手术/外科医生）。此外，与早期相比，1981 年至 1986 年间，全胰腺切除术较少（9% vs. 39%），迷走神经切除术较少（26% vs. 76%），而保留幽门的手术较多（30% vs. 0）。近期，平均手术时间（7.8 小时 vs. 9.0 小时）、平均估计失血量（1694 vs. 3271 mL）和平均术中血液置换量（3.6 vs. 6.3 单位）均显着少于前期。这些发现表明，最近手术发病率和死亡率的下降可能是由于更少的外科医生在更短的时间内进行更多的 Whipple 切除术，并且失血量更少。 38 名非胰腺壶腹周围癌患者的精算 5 年生存率为 34%。令人惊讶的是，50 名胰腺癌患者的精算 5 年生存率为 18%。此外，在没有阳性淋巴结受累的情况下，胰腺癌患者的 5 年精算生存率为 48%。对于胰腺癌患者生存率的改善，尚无明显的解释。
Between 1969 and 1986, 88 patients had a Whipple resection for adenocarcinoma of the pancreas (N = 50), ampulla (N = 19), distal bile duct (N = 10), and duodenum (N = 9). Forty-nine patients were men, 39 were women, and the mean age was 58 years (range: 34-84 years). The patients were divided into two groups on the basis of two different time periods: those operated on from 1969 to 1980 (N = 41) and those operated on from 1981 to 1986 (N = 47). There were no significant differences between the two groups in terms of mean age, sex distribution, duration of symptoms before presentation, or mean weight loss. Likewise, preoperative laboratory data were similar for both groups of patients. In addition, mean tumor size for patients with pancreatic cancer (3.5 cm vs. 3.2 cm) and patients with nonpancreatic periampullary cancer (1.9 cm vs. 2.2 cm) was similar in both groups, as was the incidence of positive lymph nodes. Among the 41 patients operated on during the first period, hospital morbidity and mortality rates were 59% and 24%, respectively. In contrast, hospital morbidity and mortality rates were 36% and 2%, respectively, among the 47 patients operated on during the recent period. During the recent period, more Whipple procedures were performed each year (7.8 vs. 3.4) and by fewer surgeons (3.4 operations/surgeon vs. 1.9 operations/surgeon). In addition, between 1981 and 1986, there were fewer total pancreatectomies (9% vs. 39%), fewer vagotomies (26% vs. 76%), and more pyloric-preserving procedures (30% vs. 0) performed compared with the earlier period. During the recent period, mean operative time (7.8 vs. 9.0 hours), mean estimated blood loss (1694 vs. 3271 mL), and mean intraoperative blood replacement (3.6 vs. 6.3 units) were all significantly less than in the earlier period. These findings suggest that the recent decline in operative morbidity and mortality may be due to fewer surgeons performing more Whipple resections in less time and with less blood loss. The actuarial 5-year survival rate for the 38 patients with nonpancreatic periampullary cancer was 34%. Surprisingly, the actuarial 5-year survival rate among the 50 patients with pancreatic cancer was 18%. Moreover, in the absence of positive lymph node involvement, the 5-year actuarial survival rate among patients with pancreatic cancer was 48%. No explanation is obvious for the improvement in survival among patients with pancreatic cancer.