Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200433, China.
School of Basic Medicine, Naval Medical University (Second Military Medical University), Shanghai, 200433, China.
Langenbecks Arch Surg. 2022 Jun;407(4):1517-1524. doi: 10.1007/s00423-022-02494-9. Epub 2022 Mar 19.
Pancreatic surgery is a complex operation that has been associated with severe intraoperative and postoperative complications, especially in patients with previous abdominal surgery (PAS). Our study aimed to assess the impact of PAS on pancreatic surgery.
A total of 1430 patients who underwent pancreatic surgery were included in this retrospective study and classified into the following 3 groups: previous upper abdominal surgery (PUAS) (n = 135); previous lower abdominal surgery (PLAS) (n = 161), and no history of abdominal surgery (non-PAS) (n = 1134). Using propensity score matching (PSM), patients were matched to one another at a 1:1:1 ratio with balanced baseline characteristics. Intraoperative factors, surgical complications, hospital costs, and postoperative hospitalization were collected and compared.
A longer operative duration was observed in the PUAS group compared to the non-PAS group (187.54 vs. 150.50 min, p = 0.016). The intraoperative blood loss in the PUAS group was significantly higher (193.68 vs. 150.51 and 156.81 mL, p < 0.05), while the intraoperative plasma transfusion volume was higher in PLAS patients than in non-PAS patients (183.8 vs. 102.7 mL, p = 0.008). Intra-abdominal adhesions in PUAS patients were most severe, and non-PAS patients exhibited significantly lower intra-abdominal adhesion grading (p < 0.001). No significant differences were observed in postoperative complications, postoperative histopathology, postoperative hospitalization, or hospital cost.
PAS has no significant influences on surgical outcomes, and pancreatic surgery is relatively safe in this patient population. A patient history of PAS may prolong operation duration and increase intraoperative blood loss but has no impact on postoperative complications and does not increase the economic burden.
胰腺手术是一种复杂的手术，其术后并发症发生率高，尤其在有既往腹部手术（PAS）史的患者中更为明显。本研究旨在评估 PAS 对胰腺手术的影响。
回顾性分析 1430 例行胰腺手术的患者的临床资料，根据既往腹部手术史分为三组：既往上腹部手术史（PUAS）组（n=135）、既往下腹部手术史（PLAS）组（n=161）和无腹部手术史（non-PAS）组（n=1134）。采用倾向性评分匹配（PSM）法，以 1:1:1 的比例进行配对，使各组间基线资料均衡可比。比较三组患者术中情况、术后并发症、住院费用和术后住院时间等。
与 non-PAS 组相比，PUAS 组手术时间更长（187.54 比 150.50 分钟，p=0.016），术中出血量更多（193.68 比 150.51 和 156.81 毫升，p<0.05），PLAS 组术中输血量多于 non-PAS 组（183.8 比 102.7 毫升，p=0.008）。PUAS 组腹腔粘连最严重，non-PAS 组腹腔粘连分级最低（p<0.001）。三组患者术后并发症、术后病理、术后住院时间和住院费用差异均无统计学意义。
PAS 对胰腺手术的手术效果无显著影响，该类患者行胰腺手术相对安全。既往腹部手术史可能会延长手术时间，增加术中出血量，但对术后并发症无影响，也不会增加经济负担。
