Department of Surgery, Tribhuwan University Teaching Hospital, GPO Box No 3578, Maharajgunj, Kathmandu, Nepal.
World J Surg. 2010 Aug;34(8):1916-21. doi: 10.1007/s00268-010-0589-y.
Pancreaticodudenectomy (PD) is a high-risk, technically demanding operation associated with substantial perioperative morbidity and mortality. This review is intended to evaluate the perioperative outcomes of PD done in a single gastrointestinal surgery unit of a university teaching hospital.
A retrospective review of medical records of patients who underwent PD from April 2005 through May 2009 was done. Perioperative morbidity was defined according to the standard of the International Study Group for Pancreatic Fistula (ISGPF). The patient demographics, type of surgery, and perioperative morbidity and mortality were evaluated. The factors associated with increased morbidity were analyzed.
Twenty-four patients underwent PD, and there were no perioperative deaths. The overall morbidity was 58%, with a pancreatic fistula rate of 13%. None of the associated parameters, like increasing age, the presence of co-morbidity, preoperative biliary drainage, and duration of surgery, were found to increase the morbidity. These results of PD, though a small case series, are comparable to the international standard. Better outcomes can be achieved even in low- to medium-volume centers in developing countries where a dedicated team with special interest in pancreatic surgery is in place.
Although there were no deaths after PD in our series, the morbidity was higher than that observed in other high-volume centers. To decrease the morbidity associated with PD, various factors must be streamlined, among them, the operative technique and the intensive perioperative management of the patient, as well as uniform definition of complications, use of a multidisciplinary approach, and identification of associated risk factors.
胰十二指肠切除术（PD）是一种高风险、技术要求高的手术，围手术期发病率和死亡率都很高。本研究旨在评估在一家大学教学医院的单一胃肠外科病房进行 PD 的围手术期结果。
对 2005 年 4 月至 2009 年 5 月期间接受 PD 的患者的病历进行了回顾性分析。根据国际胰腺瘘研究组（ISGPF）的标准定义围手术期发病率。评估了患者的人口统计学特征、手术类型以及围手术期发病率和死亡率。分析了与发病率增加相关的因素。
24 例患者接受了 PD，无围手术期死亡。总发病率为 58%，胰瘘发生率为 13%。没有任何相关参数，如年龄增长、合并症、术前胆道引流和手术时间，被发现会增加发病率。尽管这只是一个小的病例系列，但 PD 的这些结果与国际标准相当。即使在发展中国家，在设有专门的胰腺外科团队的低至中等容量中心，也可以取得更好的结果。
尽管我们的研究中 PD 后没有死亡病例，但发病率高于其他高容量中心。为了降低 PD 相关的发病率，必须优化各种因素，包括手术技术和患者的围手术期管理，以及统一并发症定义、采用多学科方法和识别相关风险因素。
