Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, University of Sydney, St Leonards, Australia.
Am J Surg. 2013 Oct;206(4):518-25. doi: 10.1016/j.amjsurg.2013.01.040. Epub 2013 Jun 27.
Early inferior pancreaticoduodenal artery (IPDA) ligation reduces intraoperative blood loss during pancreatoduodenectomy, but the impact on oncologic and long-term outcomes remains unknown. The aim of this study was to review the impact of complete pancreatic head devascularization during pancreatoduodenectomy on blood loss, transfusion rates, and clinicopathologic outcomes.
Clinicopathologic and outcome data were retrieved from a prospective database for all pancreatoduodenectomies performed from April 2004 to November 2010 and compared between early (IPDA+; n = 62) and late (IPDA-; n = 65) IPDA ligation groups.
Early IPDA ligation was associated with reduced blood loss (394 ± 21 vs 679 ± 24 ml, P < .001) and perioperative transfusion (P = .031). A trend toward improved R0 resection was seen in patients with pancreatic adenocarcinoma (IPDA+ vs IPDA-, 100% vs 82%; P = .059), but this did not translate to improved 2-year (IPDA+ vs IPDA-, 76% vs 65%; P = .426) or overall (P = .82) survival.
Early IPDA ligation reduces blood loss and transfusion requirements. Despite overall survival being unchanged, a trend toward improved R0 resection is encouraging and justifies further studies to ascertain the true oncologic significance of this technique.
在胰十二指肠切除术（PD）中早期结扎胰下十二指肠动脉（IPDA）可减少术中失血量，但对肿瘤学和长期结果的影响尚不清楚。本研究旨在回顾在 PD 期间完全胰腺头部去血管化对出血量、输血率和临床病理结果的影响。
从 2004 年 4 月至 2010 年 11 月期间前瞻性数据库中检索所有行 PD 的临床病理和结果数据，并比较早期（IPDA+；n = 62）和晚期（IPDA-；n = 65）IPDA 结扎组之间的差异。
早期 IPDA 结扎与减少出血量（394 ± 21 与 679 ± 24 ml，P <.001）和围手术期输血（P =.031）相关。在胰腺腺癌患者中，IPDA+与 IPDA-的 R0 切除率有改善趋势（100% vs 82%；P =.059），但这并未转化为 2 年（IPDA+ vs IPDA-，76% vs 65%；P =.426）或总体（P =.82）生存率的改善。
早期 IPDA 结扎可减少出血量和输血需求。尽管总体生存率保持不变，但 R0 切除率改善的趋势令人鼓舞，这证明了进一步研究该技术的真正肿瘤学意义是合理的。
