Pancreaticoduodenectomy - A 20-year experience in 516 patients
Pancreaticoduodenectomy - A 20-year experience in 516 patients
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DOI：
10.1001/archsurg.139.7.718
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发表时间：
2004-07-01
影响因子：
--
通讯作者：
Madura, JA
中科院分区：
文献类型：
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作者：
Schmidt, CM;Powell, ES;Madura, JA
假设：胰腺十二指肠切除术(PD)是治疗各种壶腹周围疾病的安全方法。设计：对前瞻性收集的数据库进行回顾。地点：大学三级保健医院。患者：共516名连续接受PD的患者。主要观察指标：患者预后和生存因素。结果：病理检查显示壶腹周围癌57%，慢性胰腺炎22%，囊性肿瘤12%，胰岛细胞肿瘤4%，其他5%。51%的患者接受了幽门保留手术。中位手术时间5小时，出血量1300毫升，输血量1.5 U。术后并发症发生率为43%，包括心肺事件(15%)、瘘(9%)、胃排空延迟(7%)和脓毒症(6%)。3%的患者需要额外的手术，最常见的原因是出血。围手术期死亡率为3.9%，但在慢性胰腺炎患者中仅为1.8%；25%的死亡患者术前有与壶腹周围状况相关的并发症。胰腺癌切除后的三年生存率为15%，十二指肠癌为42%，壶腹癌为53%，胆管癌为62%。影响壶腹周围腺癌患者长期生存的单因素包括血糖升高、肝功能检查结果、肿瘤标志物异常、失血、输血需求、手术方式和病理结果(壶腹周围腺癌类型、分化程度、切缘和结节状况)。多变量预测因素是血清总胆红素水平、出血量、手术类型、诊断和淋巴结状况。结论：胰腺十二指肠切除术仍有相当高的发病率。在仔细选择病人的情况下，可以安全地进行PD。壶腹周围腺癌患者的长期存活率可以通过术前化验值、术中因素和病理结果来预测。
Hypothesis: Pancreaticoduodenectomy (PD) is a safe procedure for a variety of periampullary conditions.Design: Retrospective review of a prospectively collected database.Setting: Academic tertiary care hospital.Patients: A total of 516 consecutive patients who underwent PD.Main Outcome Measures: Patient outcomes and survival factors.Results: Pathological examination demonstrated 57% periampullary cancers, 22% chronic pancreatitis, 12% cystic neoplasms, 4% islet cell neoplasms, and 5% other. Fifty-one percent of patients underwent pylorus preservation. Median operating time was 5 hours; blood loss, 1300 mL; and transfusion requirement, 1.5 U. Postoperative complications occurred in 43% of patients, including cardiopulmonary events (15%), fistula (9%), delayed gastric emptying (7%), and sepsis (6%). Additional surgery was required in 3% of patients, most commonly because of bleeding. Perioperative mortality was 3.9% overall but only 1.8% in patients with chronic pancreatitis; 25% of patients who died had preoperative complications associated with their periampullary condition. Three-year survival was 15% after resection for pancreatic cancer, 42% for duodenal cancer, 53% for ampullary cancer, and 62% for bile duct cancer. Univariate predictors of long-term survival in patients with periampullary adenocarcinoma included elevated glucose levels, liver function test results, abnormal tumor markers, blood loss, transfusion requirement, type of operation, and pathologic findings (periampullary adenocarcinoma type, differentiation, and margin and node status). Multivariate predictors were serum total bilirubin level, blood loss, operation type, diagnosis, and lymph node status.Conclusions: Pancreaticoduodenectomy continues to be associated with considerable morbidity. With careful patient selection, PD can be performed safely. Long-term survival in patients with periampullary adenocarcinoma can be predicted by preoperative laboratory values, intraoperative factors, and pathologic findings.