Lermite Emilie, Wu Tao, Sauvanet Alain, Mariette Christophe, Paye François, Muscari Fabrice, Cunha Antonio Sa, Sastre Bernard, Arnaud Jean-Pierre, Pessaux Patrick
Service de Chirurgie digestive, Hôpital universitaire d'Angers - Université d'Angers, France.
Digestive surgery, Hospital of Kunming - Medical University - Kunming - China.
Korean J Hepatobiliary Pancreat Surg. 2016 Feb;20(1):23-31. doi: 10.14701/kjhbps.2016.20.1.23. Epub 2016 Feb 19.
BACKGROUNDS/AIMS: The aim of this study was to describe clinical and biological changes in a group of patients who underwent pancreaticoduodenectomy (PD) without any complication during the postoperative period. These changes reflect the "natural history" of PD, and a deviation should be considered as a warning sign.
Between January 2000 and December 2009, 131 patients underwent PD. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. Postoperative variables were validated using an external prospective database of 158 patients.
The mean postoperative length of hospital stay was 20.3±4 days. The mean number of days until removal of nasogastric tube was 6.3±1.6 days. The maximal fall in hemoglobin level occurred on day 3 and began to increase after postoperative day (POD) 5, in patients with or without transfusions. The white blood cell count increased on POD 1 and persisted until POD 7. There was a marked rise in aminotransferase levels at POD 3. The peak was significantly higher in patients with hepatic pedicle occlusion (866±236 IU/L versus 146±48 IU/L; p<0.001). For both γ-glutamyl transpeptidase and alkaline phosphatase, there was a fall on POD1, which persisted until POD 5, followed with a stabilization. Bilirubin decreased progressively from POD 1 onwards.
This study facilitates a standardized biological and clinical pathway of follow-up. Patients who do not follow this recovery indicator could be at risk of complications and additional exams should be made to prevent consequences of such complications.
背景/目的：本研究旨在描述一组在术后期间未出现任何并发症的接受胰十二指肠切除术（PD）患者的临床和生物学变化。这些变化反映了PD的“自然病程”，而偏差应被视为警示信号。
2000年1月至2009年12月期间，131例患者接受了PD手术。我们前瞻性收集并回顾性分析了人口统计学数据、病理变量、相关病理状况以及术前、术中和术后变量。术后变量通过一个包含158例患者的外部前瞻性数据库进行验证。
术后平均住院时间为20.3±4天。鼻胃管拔除前的平均天数为6.3±1.6天。无论是否输血，血红蛋白水平在术后第3天下降幅度最大，术后第5天（POD 5）后开始上升。白细胞计数在POD 1时升高，并持续至POD 7。POD 3时转氨酶水平显著升高。肝蒂阻断患者的峰值明显更高（866±236 IU/L对146±48 IU/L；p<0.001）。γ-谷氨酰转肽酶和碱性磷酸酶在POD1时均下降，并持续至POD 5，随后趋于稳定。胆红素从POD 1开始逐渐下降。
本研究有助于建立标准化的生物学和临床随访路径。未遵循此恢复指标的患者可能有并发症风险，应进行额外检查以预防此类并发症的后果。
