确保胰十二指肠切除术的努力整合改善了手术结果：历史性观察研究。
Integration of effort for secure pancreaticoduodenectomy improved surgical outcomes: Historical observational study.
作者信息
Paik Kwang Yeol, Oh Ji Seon, Lee Seung Min
机构信息
Department of surgery, Yeoiudo St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
出版信息
Surg Pract Sci. 2022 Nov 13;11:100144. doi: 10.1016/j.sipas.2022.100144. eCollection 2022 Dec.
PURPOSE
To study the impact of strategies focusing attention on the safety of pancreaticoduodenectomy (PD) on postoperative outcome.
METHODS
Since 2012, tailored pancreaticoenterostomy, modification of stent insertion and organized drain management were applied according to risk for postoperative pancreatic fistula (POPF). Patients who performed PD after 2012 were enrolled into the prospective cohort, named experimental group (EG), and those who performed prior 2012 were enrolled into the historical control cohort (HG). Short term surgical outcomes were analyzed.
RESULTS
HG included 90 patients and EG included 85 patients. Overall rate of Clinically relevant (CR)-POPF was 13.7% (24/175), 18.9% in HG (17/90) and 8.2% in EG (7/85), respectively (p=0.049). Postoperative delayed gastric emptying, rate of postoperative bleeding, length of hospital stay, and mortality rate did not show any difference between groups. Postoperative complications of Clavien-Dindo 3 or higher were significantly reduced in the EG (22.2% vs 8.2%, p=0.012).
CONCLUSIONS
After the application of a new surgical policy and management, CR-POPF rate and high-grade complication rate decreased by more than half.
目的
研究关注胰十二指肠切除术（PD）安全性的策略对术后结局的影响。
方法
自2012年起，根据术后胰瘘（POPF）风险采用定制的胰肠吻合术、支架置入改良及有组织的引流管理。2012年后行PD的患者纳入前瞻性队列，称为试验组（EG），2012年前行PD的患者纳入历史对照队列（HG）。分析短期手术结局。
结果
HG组90例患者，EG组85例患者。临床相关（CR）-POPF的总体发生率为13.7%（24/175），HG组为18.9%（17/90），EG组为8.2%（7/85），差异有统计学意义（p=0.049）。术后胃排空延迟、术后出血率、住院时间和死亡率在两组间无差异。EG组Clavien-Dindo 3级及以上的术后并发症显著减少（22.2%对8.2%，p=0.012）。
结论
应用新的手术策略和管理后，CR-POPF发生率和高级别并发症发生率降低了一半以上。
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