Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.
Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan.
World J Emerg Surg. 2017 May 2;12:21. doi: 10.1186/s13017-017-0133-6. eCollection 2017.
Emergent pancreaticoduodenectomy is a life-saving procedure in certain clinical scenarios when all the conservative treatment fails. The indications can be limited into perforation and bleeding. To clarify the impact of etiology on surgical outcomes of emergent pancreaticoduodenectomy for non-trauma, we analyzed our patients and performed a literature review.
We reviewed 931 consecutive pancreaticoduodenectomies performed at our institute between January 2001 and July 2015. Patients with emergent pancreaticoduodenectomy for non-trauma etiologies were enrolled, whereas those who suffered from caustic injuries were excluded. The keywords "emergent/emergency" and "pancreaticoduodenectomy/pancreatoduodenectomy" were applied in a literature search. The universally available data for all the enrolled patients including etiology, surgical complications, outcomes, and hospital stays were analyzed. Univariate and multivariate logistic analysis for the contributing factors to surgical mortality were performed.
Six out of 931 (0.6%) registered pancreaticoduodenectomies matched our criteria of inclusion. The literature review obtained 4 series and 7 case reports, which when combined with our patients yielded a cohort of 31 emergent pancreaticoduodenectomies with 13 cases of perforation and 18 of bleeding. The rate of emergent pancreaticoduodenectomy for non-traumatic etiologies is similar between the present study and the other 3 series, ranging from 0.3 to 3%. The overall surgical complication rate was 83.9%. The rate of surgical mortality is significantly higher than in elective pancreaticoduodenectomy by propensity score matching with age and gender (19.4 versus 3.2%, = 0.015). Univariate and multivariate logistic regression disclosed that etiology is the only preoperative risk factor for surgical mortality (perforation versus bleeding; odds ratio = 39.494, = 0.031).
Emergent pancreaticoduodenectomy remains a rare operation. Surgical morbidity and mortality are higher than with elective pancreaticoduodenectomy among different reported series. By sorting the preoperative etiologies into two groups, perforation carries a higher risk of surgical mortality than bleeding.
在某些临床情况下，当所有保守治疗都失败时，紧急胰十二指肠切除术是一种救生手术。其适应证可以局限于穿孔和出血。为了阐明病因对非创伤性紧急胰十二指肠切除术手术结果的影响，我们分析了我们的患者并进行了文献复习。
我们回顾了 2001 年 1 月至 2015 年 7 月在我院进行的 931 例连续胰十二指肠切除术。纳入了因非创伤性病因而行紧急胰十二指肠切除术的患者，而排除了遭受腐蚀性损伤的患者。在文献检索中应用了“紧急/紧急”和“胰十二指肠切除术/胰十二指肠切除术”的关键词。对所有纳入患者的普遍可用数据进行了分析，包括病因、手术并发症、结果和住院时间。对手术死亡率的影响因素进行了单因素和多因素逻辑分析。
931 例胰十二指肠切除术中有 6 例（0.6%）符合我们的纳入标准。文献复习获得了 4 个系列和 7 个病例报告，将这些病例与我们的患者相结合，得到了 31 例紧急胰十二指肠切除术的队列，其中穿孔 13 例，出血 18 例。本研究与其他 3 个系列中，非创伤性病因紧急胰十二指肠切除术的发生率相似，范围为 0.3%至 3%。总的手术并发症发生率为 83.9%。手术死亡率明显高于经年龄和性别倾向评分匹配的择期胰十二指肠切除术（19.4%比 3.2%，=0.015）。单因素和多因素逻辑回归显示，病因是手术死亡率的唯一术前危险因素（穿孔比出血；优势比=39.494，=0.031）。
紧急胰十二指肠切除术仍然是一种罕见的手术。与不同报道的系列相比，手术发病率和死亡率较高。通过将术前病因分为两组，穿孔比出血的手术死亡率更高。
