Duarte Garcés Alvaro A, Andrianello Stefano, Marchegiani Giovanni, Piccolo Roberta, Secchettin Erica, Paiella Salvatore, Malleo Giuseppe, Salvia Roberto, Bassi Claudio
Departamento Cirugía Hepato Biliar y Pancreatica, Hospital Pablo Tobon Uribe, Medellìn, Colombia; General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
HPB (Oxford). 2018 Aug;20(8):702-707. doi: 10.1016/j.hpb.2018.01.013. Epub 2018 Feb 16.
Post-pancreatectomy hemorrhage (PPH) remains a major complication. The aim of this study was to reappraise the International Study Group of Pancreatic Surgery (ISGPS) classification.
The clinical utility of the ISGPS classification was tested on consecutive pancreatic resections performed at the Pancreas Institute of the University of Verona Hospital.
PPH occurred in 65 of the 2429 patients (6.8%) undergoing pancreatic resection. Outcome of patients without PPH and with grade A PPH were comparable in terms of mortality, length of stay, ICU stay and readmission. Patients with grade B late and mild and grade B early and severe PPH had similar hospital stay and mortality rates, but differed in relaparotomy rate (10.1 vs. 81.2%, p < 0.01). Replacing "time of PPH onset" criterion with post-operative pancreatic fistula (POPF), severe PPH alone, mild PPH/POPF and severe PPH/POPF differed significantly for hospital stay (14 vs. 23 vs. 35 days, p < 0.01) and mortality rate (0 vs. 4 vs. 25%, p = 0.05).
Grade A PPH shared the same outcome of patients without PPH. Grade B PPH included two categories of patients with different treatment modalities. The use of "concomitant POPF" instead of "time of onset" segregated three discrete categories that differed significantly in terms of clinical outcomes and management.
胰十二指肠切除术后出血（PPH）仍然是一种主要并发症。本研究的目的是重新评估国际胰腺手术研究组（ISGPS）的分类。
在维罗纳大学医院胰腺研究所进行的连续胰腺切除术中测试ISGPS分类的临床实用性。
在2429例接受胰腺切除术的患者中，有65例（6.8%）发生了PPH。无PPH患者和A级PPH患者在死亡率、住院时间、重症监护病房（ICU）住院时间和再入院方面的结果相当。B级晚期轻度和B级早期重度PPH患者的住院时间和死亡率相似，但再次剖腹手术率不同（10.1%对81.2%，p<0.01）。用术后胰瘘（POPF）替代“PPH发生时间”标准后，单纯重度PPH、轻度PPH/POPF和重度PPH/POPF在住院时间（14天对23天对35天，p<0.01）和死亡率（0对4对25%，p = 0.05）方面有显著差异。
A级PPH与无PPH患者的结果相同。B级PPH包括两类治疗方式不同的患者。使用“合并POPF”而非“发生时间”可将三个不同类别区分开来，这些类别在临床结果和管理方面有显著差异。
