Department of Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
Department of Surgery, University Clinical Center Tuzla, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.
Med Arch. 2023;77(5):350-353. doi: 10.5455/medarh.2023.77.350-353.
Pancreaticoduodenectomy (PD) known as Whipple procedure is still one of the most complex abdominal surgeries used for treatment of periampullary tumors. PD is often followed with postoperative complications (pancreatic, biliar or intestinal fistula, haemorrhage, intraabdominal abscess, delayed gastric empting. Severe postoperative complications (SPC) can be reason for reoperation and reason of bad outcome of treatment and life treathening condition.
To investigate predicitive value of preoperative hypoalbuminemia for severe postoperative complications (SPC) in patients who have undergone Whipple pancreaticoduodenetomy (PD). However, no similiar study has been ever reported from our country until now.
In this retrospective-prospective study, 100 patients who have had Whipple pancreaticoduodenectomy for malignant periampullary tumors at the Department for Surgery of University Clinic Center Tuzla, Bosnia and Herzegovina were enrolled, from january of 2009 to decembre of 2021. All patients were preoperatively analysed according to serum albumine levels and presensce of hypolabuminemia (serum albumine levels <32g/l). Serum albumine biochemical test were done 1-2 days preoperatively. Clavien Dindo classification was used for determination patients with SPC. Patients who did not have SPC belonged to (I-II) Clavien Dindo group of patients while those who had SPC belonged to( III-V) Clavien Dindo group of patients.
Out of 100 patients who have undergone pancreaticoduodenetomy, in 55 (55%) patients postoperative complications were noticed. Mortality rate was 18 (18%) and reoperation has been done in 20 cases (20%). SPC were noticed in 19 patients and most often were: delayed gastric emptying (20%), pancreatic fistula (13%) and intraabdominal collections (9%). Hypoalbuminemic patients had a significantly higher rate of severe postoperative complications ( p<0.05). Using hypoalbuminemia-SPC correlation analaysis, there is confirmed statistically significant correlation between hypoalbuminemia and SPC (ρ= 0.236; p<0.05).
Preoperative hypoalbuminemia can be used as predictor and prognostic factor for severe postoperative complications after Whipple pancreaticoduodenectomy. Identification and optimization of serum albumin level prior to Whipple pancreatoduodenectomy may improve surgical outcomes.
胰十二指肠切除术（PD）又称 Whipple 手术，仍然是治疗壶腹周围肿瘤最复杂的腹部手术之一。PD 术后常伴有术后并发症（胰瘘、胆瘘或肠瘘、出血、腹腔脓肿、胃排空延迟）。严重的术后并发症（SPC）可能是再次手术的原因，也是治疗和危及生命的不良预后的原因。
探讨术前低蛋白血症对行 Whipple 胰十二指肠切除术（PD）的患者发生严重术后并发症（SPC）的预测价值。然而，截至目前，尚未有来自我国的类似研究报道。
在这项回顾性前瞻性研究中，纳入了 2009 年 1 月至 2021 年 12 月在波黑图兹拉大学诊所外科接受胰十二指肠切除术治疗恶性壶腹周围肿瘤的 100 名患者。所有患者均根据血清白蛋白水平和低蛋白血症（血清白蛋白水平<32g/L）进行术前分析。术前 1-2 天进行血清白蛋白生化检查。Clavien Dindo 分类用于确定 SPC 患者。无 SPC 的患者属于（I-II）Clavien Dindo 组，有 SPC 的患者属于（III-V）Clavien Dindo 组。
在 100 例行胰十二指肠切除术的患者中，有 55 例（55%）出现术后并发症。死亡率为 18%（18%），有 20 例（20%）再次手术。19 例患者出现 SPC，最常见的是：胃排空延迟（20%）、胰瘘（13%）和腹腔积液（9%）。低蛋白血症患者严重术后并发症发生率明显较高（p<0.05）。通过低蛋白血症-SPC 相关性分析，证实低蛋白血症与 SPC 之间存在统计学显著相关性（ρ=0.236；p<0.05）。
术前低蛋白血症可作为 Whipple 胰十二指肠切除术后严重术后并发症的预测因子和预后因素。在进行 Whipple 胰十二指肠切除术之前识别和优化血清白蛋白水平可能会改善手术结果。
