Z'graggen Kaspar, Strobel Oliver, Schmied Bruno M, Zimmermann Arthur, Büchler Markus W
Department of Visceral and Transplantation Surgery, University of Bern, Switzerland.
Pancreas. 2002 Apr;24(3):258-63. doi: 10.1097/00006676-200204000-00008.
In recent years, the safety of pancreatoduodenectomy has improved, with a low mortality rate and reduced morbidity in institutions with extensive experience in the procedure. The indication for pancreatoduodenectomy has been expanded. Emergency pancreatoduodenectomy has mainly been performed for abdominal trauma.
To discuss possible indications for emergency pancreatoduodenectomy in nontrauma patients.
A series of 417 consecutive pancreatic head resections performed between November 1993 and August 2000 was reviewed for emergency interventions. Indications and outcome of emergency pancreatoduodenectomies were analyzed.
The prevalence of emergency pancreatoduodenectomy was 1%. Two patients had duodenopancreatic complications after endoscopic and surgical interventions, and two patients had otherwise uncontrollable bleeding from a penetrating duodenal ulcer and an ampullary tumor. In all four patients, emergency pancreatoduodenectomy was carried out without local complications but with a high morbidity. One patient died after surgery.
We conclude that emergency pancreatoduodenectomy may be considered, under exceptional circumstances, by surgeons experienced in pancreatic resections, but unfavorable perioperative conditions should be included in the preoperative planning and risk assessment of such patients.
近年来，胰十二指肠切除术的安全性有所提高，在对此手术有丰富经验的机构中，死亡率较低且发病率有所降低。胰十二指肠切除术的适应证已有所扩大。急诊胰十二指肠切除术主要用于腹部创伤。
探讨非创伤患者急诊胰十二指肠切除术的可能适应证。
回顾了1993年11月至2000年8月期间连续进行的417例胰头切除术，以了解急诊干预情况。分析了急诊胰十二指肠切除术的适应证和结果。
急诊胰十二指肠切除术的发生率为1%。2例患者在内镜和手术干预后出现十二指肠胰腺并发症，2例患者分别因穿透性十二指肠溃疡和壶腹肿瘤导致无法控制的出血。所有4例患者均接受了急诊胰十二指肠切除术，无局部并发症，但发病率较高。1例患者术后死亡。
我们得出结论，在特殊情况下，有胰腺切除术经验的外科医生可考虑进行急诊胰十二指肠切除术，但此类患者的围手术期不利情况应纳入术前规划和风险评估。
