Pancreatic fistula after pancreatic head resection
Pancreatic fistula after pancreatic head resection
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DOI：
10.1046/j.1365-2168.2000.01465.x
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发表时间：
2000-07-01
影响因子：
9.6
通讯作者：
Z'graggen, K
中科院分区：
文献类型：
--
作者：
Büchler, MW;Friess, H;Z'graggen, K
背景：胰腺切除术可以非常安全地进行。然而，据报告，发病率为40- 60%，胰腺并发症发病率很高。本研究的目的是分析胰头切除术后的并发症，特别注意发病率和胰fistulation.Methods：从1993年11月至1999年5月，从331例连续进行胰头切除术的围手术期和术后数据进行了前瞻性记录。数据进行了分析，并根据程序进行分组：经典的维普莱切除术，幽门保留胰头切除术（PPPD）或幽门保留胰头切除术（DPPHR.Results）：胰头切除术的死亡率为2.1%，三组之间的死亡率差异（0.9- 3.0%）是不显着的。总发病率和当地发病率分别为38.4%和28%。DPPHR在局部和全身的发病率均低于胰腺切除术。胰瘘的患病率为2.1%，在331例，也不依赖于手术或病因的疾病。3.9%的患者进行了再次手术，主要是因为出血和非胰瘘。胰瘘的患者都不需要再次手术或在术后course.Conclusion死亡：一个标准化的技术和不断努力，以提高围手术期管理可能是负责胰头切除术后的低死亡率和手术并发症率。维普莱、PPPD和DPPHR手术的胰腺并发症发生率相似。胰头切除术后，胰瘘似乎不再是一个主要问题，很少需要手术治疗。
Background: Pancreatic resections can be performed with great safety. However, the morbidity rate is reported to be 40-60 per cent with a high prevalence of pancreatic complications. The aim of this study was to analyse complications after pancreatic head resection, with particular attention to morbidity and pancreatic fistula.Methods: From November 1993 to May 1999, perioperative and postoperative data from 331 consecutive patients undergoing pancreatic head resection were recorded prospectively. Data were analysed and grouped according to the procedure performed: classic Whipple resection, pylorus-preserving pancreatoduodenectomy (PPPD) or duodenum-preserving pancreatic head resection (DPPHR).Results: Pancreatic head resection had a mortality rate of 2.1 per cent; the difference in mortality rate between the three groups (0.9-3.0 per cent) was not significant. Total and local morbidity rates were 38.4 and 28 per cent respectively. DPPHR had a lower morbidity, both local and systemic, than pancreatoduodenectomy. The prevalence of pancreatic fistula was 2.1 per cent in 331 patients, and was nor dependent on the procedure or the aetiology of the disease. Reoperations were performed in 3.9 per cent of patients, predominantly for bleeding and non-pancreatic fistula. None of the patients with pancreatic fistula required reoperation or died in the postoperative course.Conclusion: A standardized technique and a continuing effort to improve perioperative management may be responsible for low mortality and surgical morbidity rates after pancreatic head resection. Pancreatic complications occur with Whipple, PPPD and DPPHR procedures with a similar prevalence. Pancreatic fistula no longer seems to be a major problem after pancreatic head resection and rarely necessitates surgical treatment.