Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Hepatobiliary Pancreat Dis Int. 2019 Oct;18(5):478-483. doi: 10.1016/j.hbpd.2019.02.001. Epub 2019 Feb 21.
Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the treatment of localized peri‑ampullary pathologies. The concept of treatment standardization has been well-established in many high-volume centers in the world. Here, we present our experience in pancreaticoduodenectomy from 1994 to 2015.
We performed a retrospective review of the medical charts of patients who underwent pancreaticoduodenectomy at our institution. Data was entered to SPSS statistical software and analyzed. The Mann-Whitney U and Fisher's exact tests were used to report statistical differences between groups.
Of the 370 patients who underwent pacreaticoduodenectomy, 300 were analyzed. The 1-, 3-, 5- and 10-year survival rates were 85%, 35%, 15%, and 7%, respectively with a 30-day mortality rate of 5.0% (15 patients). The median age of the patients was 61 (13-84) years, with 193 (64.3%) males and 107 (35.7%) females. The median operative time was 300 (130-570) min. The median postoperative length of hospital stay was 12 (5-76) days. Thirty-two patients required re-laparotomies; 10 for pancreatic leak, 7 for biliary leak and 15 for control of bleeding. Seventy-five (25.0%) patients developed pancreatic fistulae. Delayed gastric emptying was present in 31 (10.3%) patients. A significant improvement in surgical outcome was observed in cases done after 2008 which indicates the important role of specialized team in surgical management.
The number of patients undergoing pancreaticoduodenectomy has been increasing annually over the past twenty-two years in our institution with results comparable to published series from high-volume centers. Through standardization of surgical techniques and perioperative management carried out by a specialist team, our results continue to improve despite the increasing complexity of cases referred to our unit.
胰十二指肠切除术是一种具有挑战性的手术干预措施，仍然是治疗局部壶腹周围病变的基石。在世界上许多高容量中心，治疗标准化的概念已经得到很好的建立。在这里，我们介绍了我们从 1994 年到 2015 年在胰十二指肠切除术方面的经验。
我们对在我们机构接受胰十二指肠切除术的患者的病历进行了回顾性审查。数据输入到 SPSS 统计软件中进行分析。使用 Mann-Whitney U 和 Fisher's 确切检验报告组间的统计学差异。
在 370 例接受胰十二指肠切除术的患者中，对 300 例进行了分析。1、3、5 和 10 年生存率分别为 85%、35%、15%和 7%，30 天死亡率为 5.0%（15 例）。患者的中位年龄为 61（13-84）岁，男性 193 例（64.3%），女性 107 例（35.7%）。中位手术时间为 300（130-570）分钟。术后中位住院时间为 12（5-76）天。32 例患者需要再次剖腹手术；10 例为胰漏，7 例为胆漏，15 例为出血控制。75 例（25.0%）患者发生胰瘘。31 例（10.3%）患者出现胃排空延迟。2008 年后手术结果明显改善，这表明专门团队在手术管理中的重要作用。
在过去的 22 年中，我院接受胰十二指肠切除术的患者数量逐年增加，结果与高容量中心发表的系列结果相当。通过专门团队进行的手术技术和围手术期管理的标准化，尽管我们科室收治的病例越来越复杂，但我们的结果仍在不断改善。
