Department of Surgery, Second Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic.
Department of Bioinformatics, Second Faculty of Medicine of Charles University, Prague, Czech Republic.
BMC Gastroenterol. 2024 Oct 2;24(1):345. doi: 10.1186/s12876-024-03338-0.
Conservative treatment of chronic pancreatitis has only a limited effect in most patients. Surgery offers very good long-term results, even in the early stages of the disease. Unfortunately, only a minority of patients undergo surgical treatment. The aim of this work was to summarise the current treatment options for patients with an inflammatory mass of the pancreatic head. Data from patients in our study demonstrates that the surgery is a safe method, and here we compare the perioperative and early postoperative outcomes of patients who underwent a pancreatoduodenectomy and duodenum-preserving pancreatic head resection for chronic pancreatitis.
All patients who underwent a pancreaticoduodenectomy or a duodenum-preserving pancreatic head resection in our department between 2014 and 2022 were included in this study. Perioperative and early postoperative results were statistically analysed and compared.
Thirty-eight pancreaticoduodenectomies and 23 duodenum-preserving pancreatic head resections were performed. The overall mortality was 3%, whereas the in-hospital mortality after pancreaticoduodenectomy was 5%. The mortality after duodenum-preserving pancreatic head resection was 0%. No statistically significant differences in the hospital stay, blood loss, and serious morbidity were found in either surgery. Operative time was significantly shorter in the duodenum-preserving pancreatic head resection group.
Both pancreatoduodenectomy and duodenum-preserving pancreatic head resection are safe treatment options. Duodenum-preserving pancreatic head resection showed a statistically significant superiority in the operative time compared to pancreaticoduodenectomy. Although other monitored parameters did not show a statistically significant difference, the high risk of complications after pancreaticoduodenectomy with a mortality of 5%; maintenance of the duodenum and upper loop of jejunum, and lower risk of metabolic dysfunctions after duodenum-preserving pancreatic head resection may favour duodenum-preserving pancreatic head resection in recommended diagnoses. Attending physicians should be more encouraged to use a multidisciplinary approach to assess the suitability of surgical treatment in patients with chronic pancreatitis.
在大多数患者中，慢性胰腺炎的保守治疗效果有限。手术提供了非常好的长期效果，即使在疾病的早期阶段也是如此。不幸的是，只有少数患者接受了手术治疗。这项工作的目的是总结目前治疗胰头部炎性肿块患者的治疗选择。我们研究中的患者数据表明，该手术是一种安全的方法，在这里我们比较了因慢性胰腺炎行胰十二指肠切除术和保留十二指肠胰头切除术的患者的围手术期和早期术后结果。
我们科室在 2014 年至 2022 年间对所有接受胰十二指肠切除术或保留十二指肠胰头切除术的患者进行了这项研究。对围手术期和早期术后结果进行了统计学分析和比较。
共进行了 38 例胰十二指肠切除术和 23 例保留十二指肠胰头切除术。总死亡率为 3%，胰十二指肠切除术后院内死亡率为 5%。保留十二指肠胰头切除术无死亡病例。在住院时间、出血量和严重发病率方面，两种手术均无统计学差异。保留十二指肠胰头切除术的手术时间明显短于胰十二指肠切除术。
胰十二指肠切除术和保留十二指肠胰头切除术都是安全的治疗选择。与胰十二指肠切除术相比，保留十二指肠胰头切除术在手术时间方面具有统计学优势。尽管其他监测参数没有显示出统计学差异，但胰十二指肠切除术后并发症风险高，死亡率为 5%；保留十二指肠和上段空肠，以及保留十二指肠胰头切除术后代谢功能障碍风险较低，可能有利于推荐诊断中保留十二指肠胰头切除术。应鼓励主治医生更多地采用多学科方法评估慢性胰腺炎患者手术治疗的适宜性。
