Aziz Amr Mostafa, Abbas Ahmed, Gad Hisham, Al-Saif Osama H, Leung Kam, Meshikhes Abdul-Wahed N
Section of Hepato-pancreatico-biliary Surgery, King Fahad Specialist Hospital, Dammam 31444, Eastern Province, Saudi Arabia.
J Egypt Natl Canc Inst. 2012 Mar;24(1):47-54. doi: 10.1016/j.jnci.2011.12.007. Epub 2012 Feb 24.
Perioperative outcome of pancreaticoduodenectomy is related to work load volume and to whether the procedure is carried out in a tertiary specialized hepato-pancreatico-biliary (HPB) unit.
To evaluate the perioperative outcome associated with pancreaticoduodenectomy in a newly established HPB unit.
Analysis of 32 patients who underwent pancreaticoduodenectomy (PD) for benign and malignant indications.
Retrospective collection of data on preoperative, intraoperative and postoperative care of all patients undergoing PD.
Thirty-two patients (16 male and 16 female) with a mean age of 59.5±12.7years were analyzed. The overall morbidity rate was high at 53%. The most common complication was wound infection (n=11; 34.4%). Pancreatic and biliary leaks were seen in 5 (15.6%) and 2 (6.2%) cases, respectively, while delayed gastric emptying was recorded in 7 (21.9%). The female sex was not associated with increased morbidity. Presence of co-morbid illness, pylorus-preserving PD, intra-operative blood loss ⩾1L, and perioperative blood transfusion were not associated with significantly increased morbidity. The overall hospital mortality was 3.1% and the cumulative overall (OS) and disease free survival (DFS) at 1year were 80% and 82.3%, respectively. The cumulative overall survival for pancreatic cancer vs ampullary tumor at 1year were 52% vs 80%, respectively.
PD is associated with a low risk of operative death when performed by specialized HPB surgeons even in a tertiary referral hospital. However, the postoperative morbidity rate remains high, mostly due to wound infection. Further improvement by reducing postoperative infection may help curtail the high postoperative morbidity.
胰十二指肠切除术的围手术期结果与工作量以及该手术是否在三级专科肝胰胆（HPB）科室进行有关。
评估新建HPB科室中与胰十二指肠切除术相关的围手术期结果。
分析32例行胰十二指肠切除术（PD）的患者，手术指征为良性和恶性。
回顾性收集所有接受PD患者术前、术中和术后护理的数据。
分析了32例患者（16例男性和16例女性），平均年龄为59.5±12.7岁。总体发病率较高，为53%。最常见的并发症是伤口感染（n = 11；34.4%）。分别有5例（15.6%）和2例（6.2%）出现胰瘘和胆瘘，7例（21.9%）记录有胃排空延迟。女性与发病率增加无关。合并疾病、保留幽门的PD、术中失血≥1L和围手术期输血与发病率显著增加无关。总体医院死亡率为3.1%，1年时的累积总生存率（OS）和无病生存率（DFS）分别为80%和82.3%。胰腺癌与壶腹肿瘤1年时的累积总生存率分别为52%和80%。
即使在三级转诊医院，由专业HPB外科医生进行PD手术时，手术死亡风险较低。然而，术后发病率仍然较高，主要原因是伤口感染。通过减少术后感染进一步改善可能有助于降低高术后发病率。
