Early and late complications after pancreatic necrosectomy
Early and late complications after pancreatic necrosectomy
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DOI：
10.1016/j.surg.2005.01.003
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发表时间：
2005-05-01
期刊：
影响因子：
3.8
通讯作者：
Neoptolemos, JP
中科院分区：
文献类型：
--
作者：
Connor, S;Alexakis, N;Neoptolemos, JP
背景胰腺坏死的手术与高发病率和死亡率相关。本研究的目的是回顾一个大的当代系列的患者胰腺坏死切除术后的早期和晚期并发症的发生率。回顾性分析1997年至2003年间88例胰腺坏死切除术患者的临床结果。中位年龄为55.5岁（范围18-85），54例（61%）为男性，68例（77%）患有原发性胰腺感染，71例（81%）坏死> 50%，入院急性生理学和慢性健康评估评分中位数为9（范围1-21）。至手术的中位时间为31天（范围：1-161天）; 17例患者接受了微创坏死切除术，41例患者接受了开放性坏死切除术; 81例（92%）患者术后出现并发症，25例（28%）患者死亡。多器官功能衰竭（优势比= 3.4，P = 0.05）和出血（优势比= 6.1，P = 0.03）是死亡率的唯一独立预测因素。在平均28.9个月的随访中，63例存活患者中有39例（62%）出现一种或多种晚期并发症：胆管狭窄4例（6%），假性囊肿5例（8%），胰瘘8例（13%），胃肠瘘1例（2%），延迟收集3例（5%），切口疝1例（2%）; 10例（16%）患者需要干预。63例存活患者中16例（25%）发生外分泌功能不全，58例既往无糖尿病患者中19例（33%）发生内分泌功能不全。几乎所有接受坏死切除术的患者都出现了明显的早期或晚期并发症或两者兼而有之。多器官功能衰竭和术后出血是死亡率的独立预测因素。长期随访很重要，因为62%的患者出现了并发症，其中16%的并发症患者需要手术或内窥镜干预。
Background. Surgery for pancreatic necrosis is associated with a high morbidity and mortality. The aim of this study was to review the incidence of early and late complications after pancreatic necrosectomy in a large contemporary series of patients.Methods. The clinical outcomes of 88 patients who underwent pancreatic necrosectomy between 1997 and 2003 were reviewed.Results. The median age was 55.5 (range, 18-85) years, 54 (61%) were males, 68 (77%) had primary pancreatic infection, 71 (81%) had > 50% necrosis, and the median admission Acute Physiology and Chronic Health Evaluation score was 9 (range, 1-21). Median time to surgery was 31 (range, 1-161) days; 17 patients underwent minimally invasive necrosectomy and 41 open necrosectomy; 81 (92%) of patients had complications postoperatively, and 25 (28%) died. Multiorgan failure (odds ratio = 3.4, P = .05) and hemorrhage (odds ratio = 6.1, P = .03) were the only independent predictors Of mortality. During a median follow-up of 28.9 months, 39 (62%) of 63 surviving patients had one or more late complications: biliary stricture in 4 (6%), pseudocyst in 5 (8%), pancreatic fistula in 8 (13%), gastrointestinal fistula in 1 (2%), delayed collections in 3 (5%), and incisional hernia in 1 (2%); intervention was required in 10 (16%) patients. Sixteen (25%) of 63 surviving patients developed exocrine insufficiency, and 19 (33%) of 58 without prior diabetes mellitus developed endocrine insufficiency.Conclusions. Almost all patients undergoing necrosectomy developed significant early or late complications or both. Multiorgan failure and postoperative hemorrhage were independent predictors of mortality. Long-term follow-up was important because 62% developed complications, and 16% of those with complications required surgical or endoscopic intervention.