Kleive Dyre, Sahakyan Mushegh A, Khan Ammar, Fosby Bjarte, Line Pål-Dag, Labori Knut Jørgen
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
Langenbecks Arch Surg. 2018 May;403(3):341-348. doi: 10.1007/s00423-018-1666-1. Epub 2018 Mar 21.
The incidence of intraoperative arterial injury during pancreatectomy is not well described. This study aims to evaluate the incidence, management, and outcome of arterial injuries during pancreatectomy.
This is a retrospective study of 1535 consecutive patients undergoing pancreatectomy between 2006 and 2016 at Oslo University Hospital. The type of arterial injury and potential contributing factors were analyzed. Short-term outcomes were compared between patients with arterial injury and patients undergoing a planned arterial resection due to tumor involvement.
Arterial injury was diagnosed in 14 patients (incidence 0.91%), while planned arterial resection was performed in 22 patients. The injuries were located in the superior mesenteric artery (n = 5), right hepatic artery (n = 5), common hepatic artery (n = 2), left hepatic artery (n = 1), and celiac trunk (n = 2). The artery was reconstructed in all except one patient. In 11 patients with injury, peripancreatic inflammation, aberrant arterial anatomy, close relationship between tumor and injured artery, or a combination of the three were found. Median estimated blood loss was 1100 ml in both groups. Rate of severe complications (≥ Clavien grade IIIa), comprehensive complication index, and 90-day mortality for patients with intraoperative arterial injury vs planned arterial resection were 43 vs 45% (p = 0.879), median 35.9 vs 21.8 (p = 0.287), and 14.3 vs 4.5% (p = 0.551), respectively.
Arterial injury during pancreatectomy is an infrequent and manageable complication. Early recognition and primary repair in order to restore arterial liver perfusion may improve outcome. However, the morbidity is high and comparable to patients undergoing a planned arterial resection.
胰腺切除术中动脉损伤的发生率尚无详尽描述。本研究旨在评估胰腺切除术中动脉损伤的发生率、处理方式及预后。
这是一项对2006年至2016年在奥斯陆大学医院连续接受胰腺切除术的1535例患者的回顾性研究。分析动脉损伤的类型及潜在相关因素。比较发生动脉损伤的患者与因肿瘤侵犯而进行计划性动脉切除的患者的短期预后。
14例患者被诊断为动脉损伤（发生率0.91%），22例患者进行了计划性动脉切除。损伤位于肠系膜上动脉（n = 5）、肝右动脉（n = 5）、肝总动脉（n = 2）、肝左动脉（n = 1）和腹腔干（n = 2）。除1例患者外，所有患者的动脉均进行了重建。在11例损伤患者中，发现胰腺周围炎症、动脉解剖变异、肿瘤与受损动脉关系密切或三者并存。两组患者的估计失血量中位数均为1100 ml。术中动脉损伤患者与计划性动脉切除患者的严重并发症发生率（≥Clavien IIIa级）、综合并发症指数及90天死亡率分别为43%对45%（p = 0.879）、中位数35.9对21.8（p = 0.287）和14.3%对4.5%（p = 0.551）。
胰腺切除术中的动脉损伤是一种少见且可处理的并发症。早期识别并进行一期修复以恢复肝脏动脉灌注可能改善预后。然而，其发病率较高，与计划性动脉切除患者相当。
