Junker Stefanie, Jacobsen Anne, Merkel Susanne, Denz Axel, Krautz Christian, Weber Georg F, Grützmann Robert, Brunner Maximilian
Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054 Erlangen, Germany.
J Clin Med. 2023 Apr 10;12(8):2800. doi: 10.3390/jcm12082800.
Even if the minimally invasive approach is advancing in pancreatic surgery, the open approach is still the standard for a pancreatoduodenectomy. There are two types of incisions used: the midline incision (MI) and transverse incision (TI). The aim of this study was to compare these two incision types, especially regarding wound complications.
A retrospective review of 399 patients who underwent a pancreatoduodenectomy at the University Hospital Erlangen between 2012 and 2021 was performed. A total of 169 patients with MIs were compared with 230 patients with TIs, with a focus on postoperative fascial dehiscence, postoperative superficial surgical site infection (SSSI) and the occurrence of incisional hernias during follow-up.
Postoperative fascial dehiscence, postoperative SSSI and incisional hernias occurred in 3%, 8% and 5% of patients, respectively. Postoperative SSSI and incisional hernias were significantly less frequent in the TI group (SSI: 5% vs. 12%, = 0.024; incisional hernia: 2% vs. 8%, = 0.041). A multivariate analysis confirmed the TI type as an independent protective factor for the occurrence of SSSI and incisional hernias (HR 0.45 (95% CI = 0.20-0.99), = 0.046 and HR 0.18 (95% CI = 0.04-0.92), = 0.039, respectively).
Our data suggest that the transverse incision for pancreatoduodenectomy is associated with reduced wound complications. This finding should be confirmed by a randomized controlled trial.
尽管微创方法在胰腺手术中不断发展，但开放手术仍是胰十二指肠切除术的标准术式。常用的切口有两种：中线切口（MI）和横切口（TI）。本研究的目的是比较这两种切口类型，尤其是伤口并发症方面。
对2012年至2021年在埃尔朗根大学医院接受胰十二指肠切除术的399例患者进行回顾性研究。将169例采用中线切口的患者与230例采用横切口的患者进行比较，重点关注术后筋膜裂开、术后浅表手术部位感染（SSSI）以及随访期间切口疝的发生情况。
术后筋膜裂开、术后SSSI和切口疝的发生率分别为3%、8%和5%。横切口组术后SSSI和切口疝的发生率明显较低（SSSI：5%对12%，P = 0.024；切口疝：2%对8%，P = 0.041）。多因素分析证实横切口类型是SSSI和切口疝发生的独立保护因素（HR 0.45（95%CI = 0.20 - 0.99），P = 0.046；HR 0.18（95%CI = 0.04 - 0.92），P = 0.039）。
我们的数据表明，胰十二指肠切除术采用横切口与伤口并发症减少相关。这一发现应通过随机对照试验加以证实。
