Marandola M, Cilli T, Alessandri F, Tellan G, Caronna R, Chirletti P, Delogu G
Department of Anesthesia, Critical Care, and Pain Therapy, La Sapienza University-Azienda Policlinico Umberto I, Rome, Italy.
Transplant Proc. 2008 May;40(4):1195-9. doi: 10.1016/j.transproceed.2008.03.114.
A high rate of mortality and morbidity has been associated with pancreaticoduodenectomy; the 5-year survival rate is 15% to 25% compared with 1% to 5% among those who did not have any cancer-directed treatment. Systemic rather than surgical complications cause the majority of perioperative deaths, so the anesthesiologist has a crucial role in the management of these patients. This work sought to evaluate an improved approach to perioperative pain management, postsurgical complications as well as outcomes.
From 2002 to 2007, 40 patients underwent pancreaticoduodenectomy for pancreatic or periampullary cancer. The anesthesia protocol was standardized for postoperative pain control. Patients were randomly divided into two groups: 16 patients received an epidural analgesia with local anesthetics combined with opioids (T(9)-T(10); group A) and 24 had IV analgesia with morphine (group B).
Postoperative mortality was 2.5%. With regard to complications we observed 4 biliary fistulas, 2 pancreatic fistulas with spontaneous healing in one patient and death in the other as well as wound infections. Patients treated with epidural analgesia experienced better pain relief, compared with subjects receiving IV analgesia, which demonstrated a higher incidence of opioid-related adverse effects such as sedation and respiratory depression.
Adequate perioperative treatment included suitable nutritional support and pain management using loco-regional techniques, which seem to improve the surgical outcomes among pancreatic cancer patients.
胰十二指肠切除术与高死亡率和发病率相关；5年生存率为15%至25%，而未接受任何针对癌症治疗的患者5年生存率为1%至5%。围手术期死亡大多由全身并发症而非手术并发症导致，因此麻醉医生在这些患者的管理中起着关键作用。这项研究旨在评估一种改进的围手术期疼痛管理方法、术后并发症及治疗结果。
2002年至2007年，40例患者因胰腺癌或壶腹周围癌接受了胰十二指肠切除术。术后疼痛控制的麻醉方案标准化。患者被随机分为两组：16例患者接受硬膜外局部麻醉药联合阿片类药物镇痛（T9 - T10；A组），24例接受静脉注射吗啡镇痛（B组）。
术后死亡率为2.5%。关于并发症，我们观察到4例胆瘘、2例胰瘘，其中1例患者自行愈合，另1例死亡，还有伤口感染。与接受静脉镇痛的患者相比，接受硬膜外镇痛的患者疼痛缓解更好，静脉镇痛组阿片类药物相关不良反应如镇静和呼吸抑制的发生率更高。
充分的围手术期治疗包括适当的营养支持和使用局部区域技术进行疼痛管理，这似乎能改善胰腺癌患者的手术治疗结果。
