Schmidt C Max, Powell Emilie S, Yiannoutsos Constantin T, Howard Thomas J, Wiebke Eric A, Wiesenauer Chad A, Baumgardner Joel A, Cummings Oscar W, Jacobson Lewis E, Broadie Thomas A, Canal David F, Goulet Robert J, Curie Eardie A, Cardenes Higinia, Watkins John M, Loehrer Patrick J, Lillemoe Keith D, Madura James A
Department of Surgery, University Hospital, Indiana University School of Medicine, Indianapolis, USA.
Arch Surg. 2004 Jul;139(7):718-25; discussion 725-7. doi: 10.1001/archsurg.139.7.718.
Pancreaticoduodenectomy (PD) is a safe procedure for a variety of periampullary conditions.
Retrospective review of a prospectively collected database.
Academic tertiary care hospital.
A total of 516 consecutive patients who underwent PD.
Patient outcomes and survival factors.
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.
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.
胰十二指肠切除术（PD）对于多种壶腹周围疾病来说是一种安全的手术。
对前瞻性收集的数据库进行回顾性分析。
学术性三级医疗机构。
共有516例连续接受PD手术的患者。
患者预后及生存因素。
病理检查显示，壶腹周围癌占57%，慢性胰腺炎占22%，囊性肿瘤占12%，胰岛细胞瘤占4%，其他占5%。51%的患者接受了保留幽门手术。中位手术时间为5小时；失血量为1300毫升；输血需求量为1.5单位。43%的患者发生了术后并发症，包括心肺事件（15%）、瘘（9%）、胃排空延迟（7%）和脓毒症（6%）。3%的患者需要再次手术，最常见的原因是出血。围手术期总体死亡率为3.9%，但慢性胰腺炎患者仅为1.8%；死亡的患者中有25%术前存在与壶腹周围疾病相关的并发症。胰腺癌切除术后3年生存率为15%，十二指肠癌为42%，壶腹癌为53%，胆管癌为62%。壶腹周围腺癌患者长期生存的单因素预测指标包括血糖水平升高、肝功能检查结果、肿瘤标志物异常、失血量、输血需求量、手术类型和病理结果（壶腹周围腺癌类型、分化程度、切缘及淋巴结状态）。多因素预测指标为血清总胆红素水平、失血量、手术类型、诊断及淋巴结状态。
胰十二指肠切除术仍然伴有相当高的发病率。通过仔细选择患者，PD手术可以安全进行。壶腹周围腺癌患者的长期生存可通过术前实验室检查值、术中因素及病理结果进行预测。
