根据 ISGPS 分级对胰手术后出血管理的系统评价。
A systematic review of post-pancreatectomy haemorrhage management stratified according to ISGPS grading.
机构信息
Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK.
Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK.
出版信息
HPB (Oxford). 2022 Jul;24(7):1110-1118. doi: 10.1016/j.hpb.2021.12.002. Epub 2021 Dec 31.
BACKGROUND
Morbidity and mortality from post-pancreatectomy haemorrhage (PPH) remains high. The International Study Group of Pancreatic Surgery (ISGPS) published guidelines to standardise definitions of PPH severity, management and reporting. This study aimed to i) identify the number of studies reporting PPH using ISGPS guidelines (Grade A, B or C) and ii) describe treatment modality success by grade.
METHODS
A systematic literature review was performed, identifying studies reporting PPH by ISGPS Grade and their subsequent management.
RESULTS
Of 62 studies reporting on PPH management, 17 (27.4%) stratified by ISGPS guidelines and included 608 incidences of PPH: 48 Grade A, 274 Grade B (62 early, 166 late, 46 unspecified) and 286 Grade C. 96% of Grade A PPH were treated conservatively. Of 62 early Grade B, 54.8% were managed conservatively and 37.1% surgically. Late Grade B were managed non-operatively in 25.3% (42/166), with successful endoscopy in 90.9% (10/11) and angiography in 90.3% (28/31). In Grade C, endoscopic treatment was successful in 64.4% (29/45) and angiography in 90.8% (108/119). Surgical intervention was required in 43.5% early Grade B, 7.8% late Grade B and 33.2% Grade C.
CONCLUSION
PPH grading is underreported and despite guidelines, inconsistencies remain when using definitions and reporting of outcomes.
背景
胰十二指肠切除术后出血（PPH）的发病率和死亡率仍然很高。国际胰腺外科学会（ISGPS）发布了指南，以标准化 PPH 严重程度、管理和报告的定义。本研究旨在：i）确定使用 ISGPS 指南报告 PPH 的研究数量（A级、B 级或 C 级）；ii）按等级描述治疗方式的成功率。
方法
进行了系统的文献回顾，确定了按 ISGPS 分级报告 PPH 及其后续治疗的研究。
结果
在 62 项报告 PPH 管理的研究中，有 17 项（27.4%）按 ISGPS 指南分层，包括 608 例 PPH 病例：48 例 A 级，274 例 B 级（62 例早期，166 例晚期，46 例未特指）和 286 例 C 级。96%的 A 级 PPH 采用保守治疗。62 例早期 B 级中，54.8%采用保守治疗，37.1%采用手术治疗。25.3%（42/166）的晚期 B 级患者非手术治疗，90.9%（10/11）内镜治疗成功，90.3%（28/31）血管造影成功。C 级中，内镜治疗成功率为 64.4%（29/45），血管造影成功率为 90.8%（108/119）。早期 B 级中 43.5%需要手术干预，晚期 B 级中 7.8%需要手术干预，C 级中 33.2%需要手术干预。
结论
PPH 分级报告不足，尽管有指南，但在使用定义和报告结果方面仍存在不一致。
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