全胰切除术后胃静脉淤血的风险因素、处理和转归：一种被低估的并发症，需要标准化的识别、分级和处理。
Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management.
机构信息
Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands.
出版信息
Ann Surg Oncol. 2023 Nov;30(12):7700-7711. doi: 10.1245/s10434-023-13847-z. Epub 2023 Aug 19.
BACKGROUND
Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP.
METHODS
This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC.
RESULTS
The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%; p = 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%; p = 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142-4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175-0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034-4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772-24.362).
CONCLUSIONS
After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed.
背景
尽管全胰切除术（TP）后胃静脉淤血（GVC）的发生率高达 5%至 28%，且可能与死亡率相关，但对其的研究仍很少见。本研究旨在提供关于 TP 后 GVC 的发生率、危险因素、处理和结局的见解。
方法
这是一项回顾性观察性单中心研究，纳入了 2008 年至 2021 年期间接受择期 TP 的所有患者。排除标准排除了胃切除术史、因肿瘤原因同时（次）全胃切除术或腹腔动脉切除术，以及因 GVC 以外的其他原因术后（次）全胃切除术。
结果
研究共纳入 268 例患者。院内主要并发症（Clavien-Dindo 分级≥IIIa）发生率为 28%，90 天死亡率为 3%。21%的患者出现 GVC，特别是在手术过程中（93%）。术中 GVC 采用（次）全胃切除术处理，占 55%。GVC 患者的主要并发症发生率较高（44% vs 24%；p=0.003），但 90 天死亡率无显著差异（5% vs 3%；p=0.406）。主要并发症的预测因素为术中 GVC（优势比 [OR]，2.207；95%置信区间 [CI]，1.142-4.268）和高 TP 量（>20 例/年：OR，0.360；95%CI，0.175-0.738）。GVC 的预测因素为门腔静脉切除术（PVR）（OR，2.103；95%CI，1.034-4.278）和左冠状动脉静脉结扎（OR，11.858；95%CI，5.772-24.362）。
结论
TP 后，GVC 较为常见（每 5 例患者中就有 1 例）。手术过程中出现 GVC 与主要并发症相关，但不会导致更高的死亡率。左冠状动脉静脉结扎和 PVR 是 GVC 的预测因素，需要在手术过程中和手术后保持警惕，但并不总是需要胃切除术。需要更多关于 GVC 的预防、识别、分类和处理的证据。
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