Shukla Parul J, Barreto S G, Mohandas K M, Shrikhande S V
Department of Gastrointestinal and Hepatopancreatobiliary Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
ANZ J Surg. 2009 Jan-Feb;79(1-2):33-7. doi: 10.1111/j.1445-2197.2008.04794.x.
Although mortality rates following pancreatoduodenectomy have drastically reduced over the last few decades, high morbidity rates have continued to trouble pancreatic surgeons across the world. Interventional radiology has reduced the need for re-exploration for complications following pancreatoduodenectomy. There remain specific indications for re-exploration in such scenarios. It is thus pertinent to identify those clinical scenarios where surgery still has a role in managing complications of pancreatoduodenectomy. The aim of the study was to define the role of surgery for dealing with complications following pancreatoduodenectomy.
One hundred and fifty-seven consecutive pancreatoduodenectomies carried out at a single institution between 1 January 2001 and 28 February 2007, were analysed. The database was looked into to identify patients who underwent re-exploration for complications and to define the indications for the exploration in these patients.
Out of the 157 pancreatoduodenectomies, there were, in all, 39 complications (24.2%) in 38 patients. Most of these complications were successfully managed conservatively and with the help of interventional radiology. Seventeen patients had to be re-explored (10.8%). The indications were primarily for haemorrhage, clinically significant pancreatic leaks, biliary leaks, adhesive intestinal obstruction and burst abdomen. The overall mortality rate was 3.1%. The mortality rate in the patients undergoing re-exploration was 11.7%.
Early haemorrhage (from the pancreatic stump or anastomotic line), clinically significant pancreatic anastomotic leak with discharge from the main wound and an early biliary anastomotic leak are prime indications for re-exploration in patients with complications following pancreatoduodenectomy.
尽管在过去几十年中，胰十二指肠切除术后的死亡率已大幅降低，但高发病率仍困扰着世界各地的胰腺外科医生。介入放射学减少了胰十二指肠切除术后因并发症而再次手术探查的需求。在这种情况下，仍存在再次手术探查的特定指征。因此，确定那些手术在处理胰十二指肠切除术后并发症中仍起作用的临床情况至关重要。本研究的目的是明确手术在处理胰十二指肠切除术后并发症中的作用。
对2001年1月1日至2007年2月28日在单一机构进行的157例连续性胰十二指肠切除术进行分析。查阅数据库以确定因并发症而接受再次手术探查的患者，并明确这些患者的探查指征。
在157例胰十二指肠切除术中，38例患者共出现39例并发症（24.2%）。这些并发症大多通过保守治疗和介入放射学手段成功处理。17例患者需要再次手术探查（10.8%）。指征主要为出血、具有临床意义的胰瘘、胆瘘、粘连性肠梗阻和腹部破裂。总体死亡率为3.1%。接受再次手术探查的患者死亡率为11.7%。
早期出血（来自胰腺残端或吻合口）、具有临床意义的胰腺吻合口瘘且主切口有引流物以及早期胆肠吻合口瘘是胰十二指肠切除术后并发症患者再次手术探查的主要指征。
