Management and Outcomes of Postpancreatectomy Fistula, Leak, and Abscess: Results of 908 Patients Resected at a Single Institution Between 2000 and 2005
Management and Outcomes of Postpancreatectomy Fistula, Leak, and Abscess: Results of 908 Patients Resected at a Single Institution Between 2000 and 2005
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DOI：
10.1016/j.jamcollsurg.2008.05.003
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发表时间：
2008-10-01
影响因子：
5.2
通讯作者：
Allen, Peter J.
中科院分区：
文献类型：
--
作者：
Vin, Yael;Sima, Carnella S.;Allen, Peter J.
背景：吻合口瘘、漏和脓肿是胰腺切除术的常见并发症。本研究的目的是描述我们目前的管理和临床显着的胰腺切除术后瘘，泄漏和abysites.Study设计：前瞻性维护的数据库进行审查，确定了908例患者进行胰腺切除术2000年1月至2005年8月。并发症数据前瞻性地输入经验证的术后并发症数据库。如果患者被确定为具有临床意义（≥ 2级）的胰瘘、漏或脓肿，则将其纳入研究。进行多变量分析，以确定长期引流（> 30天）的预测因素。结果：908例切除患者中有158例（17%）发生临床显著的术后瘘、漏或脓肿，其中包括63例培养阳性的胰瘘，29例未感染的胰瘘，42例脓肿和24例其他收集物（胆瘘，培养阴性收集物）。这158例患者中有88例（56%）在初次切除时放置了手术引流管。16例患者（16/88 [18%]）通过长期使用外科引流管获得了充分引流。158例患者中有26例（16%）需要再次手术。22%的患者需要入住ICU。在该组158例患者中，死亡率为5%（8/158; 90天）。在出院时，56%的患者需要家庭健康助理，8%的患者出院到康复机构，50%的患者需要再次入院。平均引流时间为38天（范围3至228天）。引流时间延长的预测因素包括前48小时内引流输出量> 200 mL（比值比= 2.88; p = 0.02）和远端（与近端）胰腺切除术（比值比= 4.29; p = 0.01）。结论：尽管胰腺切除术后死亡率已降至约2%，但与胰瘘、漏和脓肿相关的发病率仍然很高。（美国科尔外科杂志2008; 207：490-498。（D 2008由美国外科医生学会）
BACKGROUND: Anastomotic Fistula, leak, and abscess are common complications of pancreatectomy. The goal of this study was to describe our current management and Outcomes of clinically significant postpancreatectomy fistula, leak, and abscess.STUDY DESIGN: Review of a prospectively maintained database identified 908 patients who underwent pancreatectomy between January 2000 and August 2005. Complication data were prospectively entered into a validated postoperative complication database. Patients were Included if they were identified as having a clinically significant (>= grade 2) pancreatic fistula, leak, or abscess. Multivariate analyses were performed to identify factors predictive of prolonged drainage (> 30 days).RESULTS: Clinically significant postoperative Fistula, leak, or abscess occurred in 158 of 908 resected patients (17%) and included 63 culture-positive pancreatic fistulas, 29 noninfected pancreatic fistulas, 42 abscesses, and 24 other collections (biliary fistula, culture-negative collection). Surgical drains were placed at the time of initial resection in 88 of these 158 patients (56%). Adequate drainage was obtained by prolonged use Of Surgical drains in 16 patients (16 of 88 [18%]). Reoperation was required in 26 of the 158 patients (16%). ICU admission was required in 22%. Within this group of 158 patients the mortality rate was 5% (8 of 158; 90 days). At the time of discharge a home health aide was required in 56% of patients, 8% were discharged to a rehabilitation facility and readmission was required in 50% of patients. Mean drainage time was 38 days (range 3 to 228). Predictors of prolonged drainage included drain Output > 200 mL during the first 48 hours (odds ratio = 2.88; p = 0.02) and distal (versus proximal) pancreatectomy (odds ratio = 4.29; p = 0.01).CONCLUSIONS: Although mortality after pancreatectomy has decreased to approximately, 2%, the morbidity associated with pancreatic fistula, leak, and abscess remains substantial. (J Am Coll Surg 2008; 207:490-498. (D 2008 by the American College of Surgeons)