4th Department of Surgery, University Hospital Attikon, Medical School, Athens University, Athens, Greece.
Pancreas. 2010 Apr;39(3):411-4. doi: 10.1097/MPA.0b013e3181bd94ce.
Recently, hospital and surgeon volume is widely discussed as a prognostic factor after major pancreatic surgery. We present our experience regarding major pancreatectomy in a middle-volume center.
During the last 11 years, 66 patients underwent major pancreatectomy (pancreaticoduodenectomy [n = 52], distal pancreatectomy with splenectomy [n = 13], and central pancreatectomy [n = 1]). Postoperative course and long-term outcome were recorded and analyzed.
One patient died after pancreaticoduodenectomy for ampullary cancer (total mortality of approximately 1.5% for the whole group of patients or 1.9% for the group of patients who underwent pancreatoduodenectomy). None of our patients was reoperated on. Transient pancreatic fistula was observed in 46 patients (36 patients after pancreatoduodenectomy [69%] and 10 patients after distal pancreatectomy [77%]). Two patients required percutaneous computed tomography-guided drainage of fluid collections, whereas in another one, a tube thoracostomy was performed to drain a pleuritic fluid collection. Delayed gastric emptying was observed in 6 patients after pancreatoduodenectomy. Median survival for the whole group of patients was 17 months.
Major pancreatic resections can be performed safely, with acceptable morbidity and mortality and good long-term results, even in middle-volume centers. However, experience is required from the part of the operating surgeon.
PD - pancreatoduodenectomy, DP - distal pancreatectomy, PPPD - pylorus-preserving pancreatoduodenectomy.
最近，医院和外科医生的数量作为大胰脏手术后的预后因素被广泛讨论。我们报告在一个中等容量中心进行大胰脏切除术的经验。
在过去的 11 年中，有 66 名患者接受了大胰脏切除术（胰十二指肠切除术[n = 52]，远端胰腺切除术伴脾切除术[n = 13]和中央胰腺切除术[n = 1]）。记录并分析了术后过程和长期结果。
1 例壶腹癌胰十二指肠切除术患者死亡（总死亡率约为 1.5％，整个患者组或接受胰十二指肠切除术的患者组为 1.9％）。我们没有患者再次手术。46 例患者出现短暂性胰瘘（胰十二指肠切除术后 36 例[69％]和远端胰腺切除术后 10 例[77％]）。2 例需要经皮 CT 引导下引流液体积聚，另 1 例患者行胸腔引流以引流胸腔积液。6 例胰十二指肠切除术后患者出现延迟性胃排空。全组患者的中位生存时间为 17 个月。
即使在中等容量的中心，大胰脏切除术也可以安全进行，具有可接受的发病率和死亡率以及良好的长期结果，但手术医生需要有经验。
PD - 胰十二指肠切除术，DP - 远端胰腺切除术，PPPD - 保留幽门的胰十二指肠切除术。
