Satoi Sohei, Takai Soichiro, Matsui Yoichi, Terakawa Naoyoshi, Iwaki Ryuji, Fukui Jyunichi, Yanagimoto Hiroaki, Takahashi Kanji, Toyokawa Hideyoshi, Araki Hiroshi, Kwon A-Hon, Kamiyama Yasuo
Department of Surgery, Kansai Medical University, Osaka, Japan.
Pancreas. 2006 Jul;33(1):45-52. doi: 10.1097/01.mpa.0000234645.64483.5c.
The pancreaticoduodenectomy with extended resection has been frequently performed in patients with pancreatic cancer in Japan. One result of this additional surgical stress may be that postoperative complications in patients with pancreatic cancer are more frequent than in patients with periampullary cancer.
The 198 patients with pancreatic and periampullary cancer underwent pancreaticoduodenectomy. The operative mortality and morbidity between patients with pancreatic and periampullary cancer were compared, and the risk factors of postoperative complications and in-hospital death were determined.
Patients with pancreatic and periampullary cancer made up 52% and 48% of total patients. The duration of surgery and volume of intraoperative blood loss were significantly higher in patients with pancreatic cancer than in patients with periampullary cancer. Additional organ resections were frequently performed in patients with pancreatic cancer. However, significantly lower morbidity rates were observed in patients with pancreatic cancer. Among all complications evaluated, pancreatic fistula and abdominal abscess were found less frequently in patients with pancreatic cancer. Logistic regression analyses showed a positive correlation between periampullary cancer and an increased risk of complications, pancreatic fistula, and abdominal abscess. The in-hospital mortality rate has significantly reduced since 2000. When pancreatic fistula was clinically diagnosed, we immediately started a closed lavage using continuous administration of natural saline at 1000 to 4000 mL/d, after exchange of a nasogastric tube drain.
Pancreaticoduodenectomy for patients with pancreatic cancer can be a safe procedure in spite of surgical stress. Further surgical strategies will be needed to reduce postoperative complications, especially in patients with periampullary cancer.
在日本，胰腺癌患者常接受扩大切除术的胰十二指肠切除术。这种额外手术应激的一个结果可能是，胰腺癌患者术后并发症比壶腹周围癌患者更常见。
198例胰腺癌和壶腹周围癌患者接受了胰十二指肠切除术。比较了胰腺癌和壶腹周围癌患者的手术死亡率和发病率，并确定了术后并发症和院内死亡的危险因素。
胰腺癌和壶腹周围癌患者分别占总患者数的52%和48%。胰腺癌患者的手术时间和术中失血量显著高于壶腹周围癌患者。胰腺癌患者经常进行额外的器官切除。然而，胰腺癌患者的发病率显著较低。在所有评估的并发症中，胰腺癌患者发生胰瘘和腹腔脓肿的频率较低。逻辑回归分析显示，壶腹周围癌与并发症、胰瘘和腹腔脓肿风险增加呈正相关。自2000年以来，院内死亡率显著降低。当临床诊断为胰瘘时，在更换鼻胃管引流后，我们立即开始使用每天1000至4000毫升的生理盐水持续冲洗进行封闭灌洗。
尽管存在手术应激，但胰腺癌患者的胰十二指肠切除术仍可能是一种安全的手术。需要进一步的手术策略来减少术后并发症，尤其是壶腹周围癌患者。
