Rios G, Conrad A, Cole D, Adams D, Leveen M, O'Brien P, Baron P
Department of Surgery, Digestive Disease Center, Medical University of South Carolina, Charleston 29425, USA.
Am Surg. 1999 Sep;65(9):889-93.
There have been increasing changes in the role of pancreatoduodenectomy (PD) in the management of benign and malignant pancreatic disease. The aim of this paper was to compare the current role of PD with that of our earlier experience. The records of patients undergoing PD at our institution between 1983 and 1996 (Group A) were reviewed and compared with cases between 1956 and 1982 (Group B). Student's t test was used to analyze differences between groups. A total of 153 PDs were performed with 98 (64%) in Group A (88% of these in the last 6 years) and 55 (36%) in Group B. Carcinoma of the head of the pancreas was the most common indication for surgery in both periods (43% and 47% for Groups A and B, respectively). In Group A, the next most common indication was chronic pancreatitis, accounting for 28 per cent versus 13 per cent in Group B. Carcinoma of ampulla of Vater was also a common indication, making up 21 per cent of the cases in Group A and 20 per cent in Group B. Preoperative biliary drainage was performed in 62 per cent of Group A and 3 per cent of Group B patients (P < 0.001). Postoperative complications were comparable in both groups: delayed gastric emptying (22%), wound infection (17%), pancreatic fistula (13%), gastrointestinal bleeding (8%), and intestinal obstruction (3%). The perioperative mortality rate was significantly different between the two groups: 1 per cent in Group A versus 16 per cent in Group B (P < 0.001). Mean postoperative length of stay was 17 days in Group A (22 days for benign disease) and 25 days for Group B (P < 0.01). In the last 40 years, there has been a rise in the use of PD for chronic pancreatitis and a significant decrease in postoperative mortality and hospital length of stay. These data support the safety of PD in the management of patients with both benign and malignant periampullary disease.
在良性和恶性胰腺疾病的治疗中，胰十二指肠切除术（PD）的作用一直在不断变化。本文旨在比较PD目前的作用与我们早期的经验。回顾了1983年至1996年在我们机构接受PD的患者记录（A组），并与1956年至1982年的病例（B组）进行比较。采用学生t检验分析两组之间的差异。共进行了153例PD，其中A组98例（64%）（其中88%在最近6年），B组55例（36%）。胰腺头部癌是两个时期最常见的手术指征（A组和B组分别为43%和47%）。在A组中，第二常见的指征是慢性胰腺炎，占28%，而B组为13%。壶腹癌也是一个常见指征，在A组病例中占21%，在B组中占20%。A组62%的患者和B组3%的患者进行了术前胆道引流（P<0.001）。两组术后并发症相当：胃排空延迟（22%）、伤口感染（17%）、胰瘘（13%）、胃肠道出血（8%）和肠梗阻（3%）。两组围手术期死亡率有显著差异：A组为1%，B组为16%（P<0.001）。A组术后平均住院时间为17天（良性疾病为22天），B组为25天（P<0.01）。在过去40年中，PD用于慢性胰腺炎的比例有所上升，术后死亡率和住院时间显著下降。这些数据支持了PD在壶腹周围良性和恶性疾病患者管理中的安全性。
