胰腺手术趋势的回顾性分析：1120例胰腺切除术的适应证、手术技术及术后结果

Retrospective analyses of trends in pancreatic surgery: indications, operative techniques, and postoperative outcome of 1,120 pancreatic resections.

作者信息

Wittel Uwe A, Makowiec Frank, Sick Olivia, Seifert Gabriel J, Keck Tobias, Adam Ulrich, Hopt Ulrich T

机构信息

Clinic of General and Visceral Surgery, Department of Surgery, Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.

出版信息

World J Surg Oncol. 2015 Mar 12;13:102. doi: 10.1186/s12957-015-0525-6.

DOI:10.1186/s12957-015-0525-6

PMID:25880929

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4364492/

Abstract

BACKGROUND

Hospital volume, surgeons' experience, and adequate management of complications are factors that contribute to a better outcome after pancreatic resections. The aim of our study was to analyze trends in indications, surgical techniques, and postoperative outcome in more than 1,100 pancreatic resections.

METHODS

One thousand one hundred twenty pancreatic resections were performed since 1994. The vast majority of operations were performed by three surgeons. Perioperative data were documented in a pancreatic database. For the purpose of our analysis, the study period was sub-classified into three periods (A 1994 to 2001/n = 363; B 2001 to 2006/n = 305; C since 2007 to 2012/n = 452).

RESULTS

The median patient age increased from 51 (A) to 65 years (C; P < 0.001). Indications for surgery were pancreatic/periampullary cancer (49%), chronic pancreatitis (CP; 33%), and various other lesions (18%). About two thirds of the operations were pylorus-preserving pancreaticoduodenectomies. The frequency of mesenterico-portal vein resections increased from 8% (A) to 20% (C; P < 0.01). The overall mortality was 2.4% and comparable in all three periods (2.8%, 2.0%, 2.4%; P = 0.8). Overall complication rates increased from 42% (A) to 56% (C; P < 0.01).

CONCLUSIONS

Mortality remained low despite a more aggressive surgical approach to pancreatic disease. An increased overall morbidity may be explained by more clinically relevant pancreatic fistulas and better documentation.

摘要

背景

医院手术量、外科医生的经验以及并发症的妥善处理是有助于胰腺切除术后获得更好疗效的因素。我们研究的目的是分析1100多例胰腺切除术中手术指征、手术技术及术后疗效的变化趋势。

方法

自1994年以来共施行1120例胰腺切除术。绝大多数手术由三位外科医生完成。围手术期数据记录于胰腺数据库。为便于分析，研究期分为三个阶段（A：1994年至2001年/n = 363；B：2001年至2006年/n = 305；C：2007年至2012年/n = 452）。

结果

患者中位年龄从51岁（A阶段）增至65岁（C阶段；P < 0.001）。手术指征为胰腺/壶腹周围癌（49%）、慢性胰腺炎（CP；33%）及其他各种病变（18%）。约三分之二的手术为保留幽门的胰十二指肠切除术。肠系膜 - 门静脉切除术的频率从8%（A阶段）增至20%（C阶段；P < 0.01）。总体死亡率为2.4%，三个阶段相当（2.8%、2.0%、2.4%；P = 0.8）。总体并发症发生率从42%（A阶段）增至56%（C阶段；P < 0.01）。