Standop Jens, Glowka Tim, Schmitz Volker, Schäfer Nico, Overhaus Marcus, Hirner Andreas, Kalff Jörg C
Department of Surgery, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
J Gastrointest Surg. 2009 Aug;13(8):1503-9. doi: 10.1007/s11605-009-0905-8. Epub 2009 May 7.
This study analyzed indication and outcome regarding operative re-intervention following pancreatoduodenectomy (PD) and pancreatogastrostomy (PG) with special emphasis on complications related to redo surgery.
Two hundred eighty-five patients who underwent PD with PG between 1989 and 2008 were identified from a pancreatic resection database and indications for repeat surgery were registered. Patients with and without reoperation were analyzed with regard to gender, age, underlying disease, length of hospital stay, mortality rate, and postoperative complications.
Thirty-one patients (11%) underwent operative reintervention. Early intra-abdominal extraluminal postoperative bleeding was the main cause for redo surgery followed by abdominal abscesses. Thirteen percent of patients with and 1.9% without secondary surgery died during the postoperative course. Forty-five percent of reoperated patients had to undergo at least one more operation resulting in doubling of the length of hospital stay. There was no correlation between patients' gender, age, and underlying disease and the need for operative reintervention. However, redo surgery was associated with higher incidence of delayed gastric emptying, pancreatic fistula and bleeding, and non-surgery related complication. Intra-abdominal bleeding and abscesses, insufficiencies of bilio-digestive and gut anastomosis, wound infections, and pancreatitis were observed significantly more often in patients with secondary surgery.
Complications after pancreatic resection that require operative re-intervention are associated with a notably increased mortality, ranging between 13% and 60%. Apart from the surgeon's experience in selecting patients and his/her personal technical skills in performing a pancreaticoduodenectomy, timely anticipation and determined management of postoperative complications is essential for improving the outcome of this operation.
本研究分析了胰十二指肠切除术（PD）和胰胃吻合术（PG）后再次手术干预的指征和结果，特别强调了再次手术相关的并发症。
从胰腺切除数据库中识别出1989年至2008年间接受PD加PG手术的285例患者，并记录再次手术的指征。对接受再次手术和未接受再次手术的患者在性别、年龄、基础疾病、住院时间、死亡率和术后并发症方面进行分析。
31例患者（11%）接受了再次手术干预。术后早期腹腔内肠外出血是再次手术的主要原因，其次是腹腔脓肿。接受二次手术的患者中有13%在术后病程中死亡，未接受二次手术的患者中有1.9%死亡。45%接受再次手术的患者至少需要再进行一次手术，导致住院时间加倍。患者的性别、年龄和基础疾病与再次手术干预的需求之间没有相关性。然而，再次手术与胃排空延迟、胰瘘和出血以及非手术相关并发症的发生率较高有关。二次手术患者腹腔内出血和脓肿、胆肠和肠吻合口漏、伤口感染和胰腺炎的发生率明显更高。
胰腺切除术后需要再次手术干预的并发症与死亡率显著增加相关，死亡率在13%至60%之间。除了外科医生在选择患者方面的经验及其进行胰十二指肠切除术的个人技术技能外，及时预测和果断处理术后并发症对于改善该手术的结果至关重要。
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