Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Cedars-Sinai Hospital, Los Angeles, CA, USA.
Updates Surg. 2021 Apr;73(2):711-718. doi: 10.1007/s13304-020-00855-x. Epub 2020 Jul 26.
Trauma pancreaticoduodenectomy (TP) remains a challenging operation with morbidity and mortality rates as high as 80% and 50%. Many trauma surgeons consider it surgical dogma to avoid performing a TP during the index operation for patients with severe pancreatic or duodenal injuries. However, there is no modern analysis evaluating this belief. Therefore, we hypothesized no difference in risk of mortality between patients with severe pancreatic or duodenal injury undergoing a TP for penetrating trauma to propensity-matched controls undergoing laparotomy without TP. The Trauma Quality Improvement Program (2010-2016) was queried for adults with severe penetrating pancreatic or duodenal injuries undergoing laparotomy. A 1:2 propensity-matching including demographics/comorbidities, injury severity score, vitals on admission, Glasgow Coma Scale and concomitant injuries for laparotomy with or without TP was performed. Risk of mortality was reported using a univariable logistic regression model. Of 2182 patients with severe pancreatic or duodenal injuries undergoing laparotomy, 54 (2.5%) underwent TP and 2128 (97.5%) underwent laparotomy without TP. There were no differences in propensity-matching characteristics. Patients undergoing TP had a similar mortality rate (20.0% vs. 28.7%, p = 0.302) but a longer length of stay (LOS) (27.5 vs. 16.5 days, p = 0.017). The TP group had a similar associated risk of mortality (OR = 0.62, p = 0.302) but higher risk of major complications (OR 3.44, CI 1.35-17.47, p = 0.015). In appropriately selected penetrating trauma patients with severe pancreatic/duodenal injuries, TP is associated with a similar risk of mortality compared to laparotomy without TP. However, TP patients did have an increased associated risk of major complications and longer LOS.
创伤性胰十二指肠切除术（TP）仍然是一项具有挑战性的手术，其发病率和死亡率高达 80%和 50%。许多创伤外科医生认为，对于严重胰腺或十二指肠损伤的患者，在指数手术中避免进行 TP 是手术教条。然而，目前还没有对这一信念进行现代分析。因此，我们假设对于穿透性创伤的严重胰腺或十二指肠损伤患者，接受 TP 与接受无 TP 的剖腹手术的倾向性匹配对照患者在死亡率方面没有差异。创伤质量改进计划（2010-2016 年）对接受剖腹手术的严重穿透性胰腺或十二指肠损伤的成年人进行了查询。对接受或不接受 TP 的剖腹手术患者进行了包括人口统计学/合并症、损伤严重程度评分、入院时生命体征、格拉斯哥昏迷评分和合并伤在内的 1:2 倾向匹配。使用单变量逻辑回归模型报告死亡率。在 2182 名接受剖腹手术的严重胰腺或十二指肠损伤患者中，54 名（2.5%）接受了 TP，2128 名（97.5%）接受了无 TP 的剖腹手术。倾向匹配特征无差异。接受 TP 的患者死亡率相似（20.0% vs. 28.7%，p=0.302），但住院时间（LOS）较长（27.5 天 vs. 16.5 天，p=0.017）。TP 组的死亡率相关风险相似（OR=0.62，p=0.302），但主要并发症风险较高（OR 3.44，CI 1.35-17.47，p=0.015）。在适当选择的穿透性创伤患者中，对于严重的胰腺/十二指肠损伤患者，TP 与无 TP 的剖腹手术相比，其死亡率无差异。然而，TP 患者确实有更高的主要并发症相关风险和更长的 LOS。
