The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients.
The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients.
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DOI：
10.1186/s13017-017-0133-6
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Yeh TS
中科院分区：
文献类型：
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作者：
Tsai CY;Lai BR;Wang SY;Liao CH;Liu YY;Kang SC;Yeh CN;Jan YY;Yeh TS
在某些临床情况下，当所有保守治疗失败时，紧急胰腺炎切除术是一种挽救生命的手术。适应症可限于穿孔和出血。为了阐明病因对非创伤性紧急胰管切除术手术结果的影响，我们分析了我们的患者并进行了文献综述。我们回顾了2001年1月至2015年7月期间在我们研究所进行的931例连续胰腺切除术。非创伤性病因的紧急胰腺炎切除术患者入选，而那些遭受腐蚀性损伤的患者被排除在外。在文献检索中使用了关键词“急诊/急诊”和“胰管切除术/胰管切除术”。分析了所有入组患者的普遍可用数据，包括病因、手术并发症、结局和住院时间。对手术死亡率的影响因素进行单因素和多因素Logistic分析。在931例登记的胰腺切除术中，有6例（0.6%）符合我们的入选标准。文献回顾获得了4个系列和7个病例报告，结合我们的患者，产生了31例急诊胰腺切除术，其中13例穿孔，18例出血。本研究与其他3个系列的非创伤性病因的紧急胰腺炎切除率相似，范围为0.3%至3%。总手术并发症发生率为83.9%。根据与年龄和性别相匹配的倾向评分，手术死亡率显著高于择期胰腺癌切除术（19.4%对3.2%，P = 0.015）。单因素和多因素Logistic回归分析显示，病因是手术死亡率的唯一术前危险因素（穿孔与出血;比值比= 39.494，P = 0.031）。紧急胰管切除术仍然是一种罕见的手术。在不同的报道系列中，手术并发症和死亡率均高于选择性胰腺切除术。通过将术前病因分为两组，穿孔的手术死亡率高于出血。
Emergent pancreaticoduodenectomy is a life-saving procedure in certain clinical scenarios when all the conservative treatment fails. The indications can be limited into perforation and bleeding. To clarify the impact of etiology on surgical outcomes of emergent pancreaticoduodenectomy for non-trauma, we analyzed our patients and performed a literature review. We reviewed 931 consecutive pancreaticoduodenectomies performed at our institute between January 2001 and July 2015. Patients with emergent pancreaticoduodenectomy for non-trauma etiologies were enrolled, whereas those who suffered from caustic injuries were excluded. The keywords “emergent/emergency” and “pancreaticoduodenectomy/pancreatoduodenectomy” were applied in a literature search. The universally available data for all the enrolled patients including etiology, surgical complications, outcomes, and hospital stays were analyzed. Univariate and multivariate logistic analysis for the contributing factors to surgical mortality were performed. Six out of 931 (0.6%) registered pancreaticoduodenectomies matched our criteria of inclusion. The literature review obtained 4 series and 7 case reports, which when combined with our patients yielded a cohort of 31 emergent pancreaticoduodenectomies with 13 cases of perforation and 18 of bleeding. The rate of emergent pancreaticoduodenectomy for non-traumatic etiologies is similar between the present study and the other 3 series, ranging from 0.3 to 3%. The overall surgical complication rate was 83.9%. The rate of surgical mortality is significantly higher than in elective pancreaticoduodenectomy by propensity score matching with age and gender (19.4 versus 3.2%, P = 0.015). Univariate and multivariate logistic regression disclosed that etiology is the only preoperative risk factor for surgical mortality (perforation versus bleeding; odds ratio = 39.494, P = 0.031). Emergent pancreaticoduodenectomy remains a rare operation. Surgical morbidity and mortality are higher than with elective pancreaticoduodenectomy among different reported series. By sorting the preoperative etiologies into two groups, perforation carries a higher risk of surgical mortality than bleeding.