Topal B, Aerts R, Hendrickx T, Fieuws S, Penninckx F
Department of Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Eur J Surg Oncol. 2007 May;33(4):488-92. doi: 10.1016/j.ejso.2006.10.041. Epub 2006 Dec 4.
The factors determining complications after pancreaticoduodenectomy (PD) have not yet been identified clearly. This retrospective study examined, using reproducible classification systems, the type and severity of complications as well as the factors to predict them.
Between 1998 and 2005 PD was performed in 351 consecutive patients with peri-ampullary tumours. Logistic regression models were used in univariate as well as in corrected, multivariate analyses in order to identify the optimally combined factors related to the occurrence of post-operative complications.
Post-operative complication rate was 50.7%, mortality 3.1% and re-operation rate 7.1%. Pancreatic fistula (12%) was responsible for higher mortality (9.5%; p=0.011) and re-operation (30.9%; p<0.001) rates. Hospital length of stay (LOS) was (p<0.001) longer for patients with post-operative complications (median 21.5 (range 1-128) vs. 14 (7-42) days) or pancreatic fistula (28.5 (8-128) vs. 17 (1-63) days), and related to the severity of complications. Surgeon (Odds ratio [OR] 2.03; confidence interval [CI] 1.20-3.41; p=0.008), male gender (OR 1.72; CI 1.05-2.81; p=0.032), and pre-operative hyperbilirubinaemia (OR 1.04; CI 1.001-1.08; p=0.046) were independent risk factors for post-operative complications. Neither prophylactic octreotide nor pre-operative biliary drainage improved post-operative outcome.
Surgeon, male gender, and pre-operative hyperbilirubinaemia determine complication rate following PD. Pancreatic fistula is the most common complication and is associated with increased mortality, re-operation rate and LOS.
尚未明确确定胰十二指肠切除术（PD）后并发症的相关因素。本回顾性研究使用可重复的分类系统，对并发症的类型和严重程度以及预测并发症的因素进行了研究。
1998年至2005年间，对351例连续的壶腹周围肿瘤患者进行了PD手术。采用逻辑回归模型进行单因素分析以及校正后的多因素分析，以确定与术后并发症发生相关的最佳组合因素。
术后并发症发生率为50.7%，死亡率为3.1%，再次手术率为7.1%。胰瘘（12%）导致更高的死亡率（9.5%；p=0.011）和再次手术率（30.9%；p<0.001）。术后有并发症的患者（中位住院时间21.5天（范围1-128天），而无并发症患者为14天（7-42天））或有胰瘘的患者（28.5天（8-128天），而无胰瘘患者为17天（1-63天））的住院时间更长（p<0.001），且住院时间与并发症的严重程度相关。外科医生（比值比[OR]2.03；置信区间[CI]1.20-3.41；p=0.008）、男性（OR 1.72；CI 1.05-2.81；p=0.032）和术前高胆红素血症（OR 1.04；CI 1.001-1.08；p=0.046）是术后并发症的独立危险因素。预防性使用奥曲肽和术前胆道引流均未改善术后结局。
外科医生、男性性别和术前高胆红素血症决定了PD后的并发症发生率。胰瘘是最常见的并发症，与死亡率、再次手术率和住院时间增加相关。
