Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s - Pathology, complications, and outcomes
Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s - Pathology, complications, and outcomes
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DOI：
10.1097/00000658-199709000-00004
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发表时间：
1997-09-01
影响因子：
9
通讯作者：
Abrams, RA
中科院分区：
文献类型：
--
作者：
Yeo, CJ;Cameron, JL;Abrams, RA
目的回顾20世纪90年代650例连续行胰十二指肠切除术患者的病理、并发症和预后。摘要背景资料胰十二指肠切除术近年来越来越多地用于切除胰腺和壶腹周围区域的各种恶性和良性疾病。方法1990年1月至1996年7月，650例患者在约翰霍普金斯医院行胰十二指肠切除术。对所有患者进行前瞻性数据记录。对所有病理标本进行复查和分类。采用单变量和多变量模型进行统计分析。结果患者平均年龄63±12.8岁，男性占54%，白人占91%。每年切除手术的数目从1990年的60例增加到1995年的161例。病理检查结果：胰腺癌282例（43%）、壶腹癌70例（11%）、胆总管远端癌65例（10%）、十二指肠癌26例（4%）、慢性胰腺炎71例（11%）、神经内分泌肿瘤31例（5%）、壶腹周围腺瘤21例（3%）、囊腺癌14例（2%）、囊腺瘤25例（4%）、其他45例（7%）。手术包括幽门保留（82%），部分胰腺切除术（95%），门静脉或肠系膜上静脉切除术（4%）。胰肠重建，在适当的情况下，71%通过胰空肠吻合术，29%通过胰胃吻合术。术中出血量中位数为625；mL，中位红细胞输注单位为0，中位手术时间为7小时。在此期间，190例连续行胰十二指肠切除术，无一例死亡。9例死亡发生在院内或手术30天内（1.4%手术死亡率）。术后并发症发生率为41%，最常见的并发症为早期胃排空延迟（19%）、胰瘘（14%）和伤口感染（10%）。23例（3.5%）患者术后立即需要再次手术，最常见的原因是出血、脓肿或裂开。术后平均住院时间为13天。对443例壶腹周围腺癌患者的多变量分析表明，十二指肠腺癌的病理诊断、肿瘤直径是有利于长期生存的最有力的独立预测因素
ObjectiveThe authors reviewed the pathology, complications, and outcomes in a consecutive group of 650 patients undergoing pancreaticoduodenectomy in the 1990s.Summary Background DataPancreaticoduodenectomy has been used increasingly in recent years to resect a variety of malignant and benign diseases of the pancreas and periampullary region.MethodsBetween January 1990 and July 1996, inclusive, 650 patients underwent pancreaticoduodenal resection at The Johns Hopkins Hospital. Data were recorded prospectively on ail patients. All pathology specimens were reviewed and categorized. Statistical analyses were performed using both univariate and multivariate models.ResultsThe patients had a mean age of 63 +/- 12.8 years, with 54% male and 91% white. The number of resections per year rose from 60 in 1990 to 161 in 1995. Pathologic examination results showed pancreatic cancer (n = 282; 43%), ampullary cancer (n = 70; 11%), distal common bile duct cancer (n = 65; 10%), duodenal cancer (n = 26; 4%), chronic pancreatitis (n = 71; 11%), neuroendocrine tumor (n = 31; 5%), periampullary adenoma (n = 21; 3%), cystadenocarcinoma (n = 14; 2%), cystadenoma (n = 25; 4%), and other (n = 45; 7%). The surgical procedure involved pylorus preservation in 82%, partial pancreatectomy in 95%, and portal or superior mesenteric venous resection in 4%. Pancreatic-enteric reconstruction, when appropriate, was via pancreaticojejunostomy in 71% and pancreaticogastrostomy in 29%. The median intraoperative blood loss was 625; mL, median units of red cells transfused was zero, and the median operative time was 7 hours. During this period, 190 consecutive pancreaticoduodenectomies were performed without a mortality. Nine deaths occurred in-hospital or within 30 days of operation (1.4% operative mortality). The postoperative complication rate was 41%, with the most common complications being early delayed gastric emptying (19%), pancreatic fistula (14%), and wound infection (10%). Twenty-three patients required reoperation in the immediate postoperative period (3.5%), most commonly for bleeding, abscess, or dehiscence. The median postoperative length of stay was 13 days. A multivariate analysis of the 443 patients with periampullary adenocarcinoma indicated that the most powerful independent predictors favoring long-term survival included a pathologic diagnosis of duodenal adenocarcinoma, tumor diameter