Department of Surgery, University of Bonn Medical Center, Bonn, Germany.
Pancreas. 2010 Mar;39(2):156-9. doi: 10.1097/MPA.0b013e3181bb98d2.
Pancreaticoduodenectomy is a demanding procedure even in selected patients but becomes formidable when performed in cases of emergency. This study analyzed our experience with urgent pancreatoduodenectomies; special emphases were put on the evaluation of diagnostic means and the validation of existing indications for performance of this procedure.
Three hundred one patients who underwent pancreatoduodenectomy between 1989 and 2008 were identified from a pancreatic resection database and reviewed for emergency indications.
Six patients (2%) underwent emergency pancreatoduodenectomy. Indications included endoscopy-related perforation, postoperative complications, and uncontrollable intraduodenal tumor bleeding. Length of stay and occurrence of nonsurgical complications were increased in emergency compared with elective pancreatoduodenectomies. Although increased, no significant differences were found regarding mortality and surgery-related complications.
Indications for emergency pancreatoduodenectomies were based on clinical decisions rather than on radiologic diagnostics. Urgent pancreatic head resections may be considered as an option in selected patients if handling of local complications by interventional measures or limited surgery seems unsafe.
即使在选择的患者中，胰十二指肠切除术也是一项要求很高的手术，但在紧急情况下进行时，手术难度会增加。本研究分析了我们在紧急胰十二指肠切除术中的经验；特别强调了诊断方法的评估和现有手术适应证的验证。
从胰腺切除术数据库中确定了 1989 年至 2008 年间接受胰十二指肠切除术的 301 例患者，并对急诊适应证进行了回顾性分析。
6 例（2%）患者行紧急胰十二指肠切除术。适应证包括内镜相关穿孔、术后并发症和无法控制的十二指肠内肿瘤出血。与择期胰十二指肠切除术相比，急诊患者的住院时间和非手术并发症的发生率增加。虽然有所增加，但在死亡率和手术相关并发症方面没有发现显著差异。
紧急胰十二指肠切除术的适应证是基于临床决策而不是影像学诊断。如果局部并发症的处理通过介入措施或有限的手术似乎不安全，对于某些患者，紧急胰头切除术可作为一种选择。
