Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
Department of Anesthesiology, Heidelberg University Hospital, Germany.
Surgery. 2018 Dec;164(6):1185-1190. doi: 10.1016/j.surg.2018.07.024. Epub 2018 Sep 11.
Postoperative pancreatic fistula is a dangerous complication in pancreatic surgery. This study assessed the impact of microbiologic pathogens detected in postoperative pancreatic fistula on clinical outcomes after partial pancreatoduodenectomy and distal pancreatectomy.
Microorganisms in postoperative pancreatic fistula were identified by microbiologic analyses from abdominal drains or intraoperative swabs during relaparotomy. Demographic, operative, and microbiologic data, as well as postoperative outcomes were examined.
Of 2,752 patients undergoing partial pancreatoduodenectomy and distal pancreatectomy, 256 patients with clinically relevant postoperative pancreatic fistula (International Study Group of Pancreatic Surgery [ISGPS] grades B and C) were identified (9.3%) and microbiologic cultures were positive in 210 patients (82.0%), with a higher rate after partial pancreatoduodenectomy (95.8%) than after distal pancreatectomy (64.3%; P < .001). Microbiologic spectra differed distinctively between partial pancreatoduodenectomy and distal pancreatectomy. Detection of microorganisms in postoperative pancreatic fistula resulted in a higher morbidity and mortality, including postpancreatectomy hemorrhage (42.4% vs 21.7%; P = .009), sepsis (38.1% vs 6.5%; P < .001), wound infection (30.0% vs 6.5%; P = .001), reoperation (48.1% vs 10.9%; P < .001), hospital stay (median 42 vs 26 days; P < .001), and overall 90-day mortality (19.5% vs 4.3%; P = .013) and was identified as an independent risk factor for sepsis, wound infection, and reoperation in the multivariate analysis.
Detection of microorganisms in postoperative pancreatic fistula is frequent after pancreatic resection and indicates a turning point in the development of postoperative pancreatic fistula into a life-threatening condition. Whether early anti-infective therapy in combination with interventional measures or a surgical reintervention are warranted, has yet to be elucidated.
术后胰瘘是胰腺手术后的一种危险并发症。本研究评估了在胰十二指肠切除术和胰体尾切除术部分切除术后检测到的术后胰瘘微生物病原体对临床结果的影响。
通过对剖腹引流物或再次剖腹术中的术中拭子进行微生物分析，确定术后胰瘘中的微生物。检查人口统计学、手术和微生物数据以及术后结果。
在 2752 例行胰十二指肠切除术和胰体尾切除术的患者中，发现 256 例有临床相关的术后胰瘘（国际胰腺外科研究组 [ISGPS] 分级 B 和 C）（9.3%），210 例（82.0%）微生物培养阳性，胰十二指肠切除术的阳性率更高（95.8%），而胰体尾切除术的阳性率（64.3%；P<.001）。胰十二指肠切除术和胰体尾切除术之间的微生物谱明显不同。术后胰瘘中检测到微生物会导致更高的发病率和死亡率，包括胰切除术后出血（42.4% vs. 21.7%；P=.009）、败血症（38.1% vs. 6.5%；P<.001）、伤口感染（30.0% vs. 6.5%；P=.001）、再次手术（48.1% vs. 10.9%；P<.001）、住院时间（中位数 42 天 vs. 26 天；P<.001）和 90 天总死亡率（19.5% vs. 4.3%；P=.013），并且在多变量分析中被确定为败血症、伤口感染和再次手术的独立危险因素。
胰腺切除术后术后胰瘘中微生物的检测很常见，表明术后胰瘘发展为危及生命的状态的转折点。是否需要早期抗感染治疗联合介入措施或再次手术干预，仍有待阐明。
