Barens S A, Lillemoe K D, Kaufman H S, Sauter P K, Yeo C J, Talamini M A, Pitt H A, Cameron J L
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Am J Surg. 1996 Jan;171(1):131-4; discussion 134-5. doi: 10.1016/s0002-9610(99)80087-7.
Surgeons are often called upon to perform pancreaticoduodenectomy for either suspicion of malignancy or symptoms due to benign disease. Perioperative morbidity and mortality following pancreaticoduodenectomy have decreased markedly over the last 2 decades. In response, many surgical centers advocate expanding the indications for pancreaticoduodenectomy to include lesions other than periampullary carcinoma.
A retrospective review of medical records for 108 patients undergoing pancreaticoduodenectomy for benign disease at The Johns Hopkins Medical Institutions over 100 months was completed. The subset of patients with a histopathologic diagnosis of chronic pancreatitis was identified and compared with patients undergoing pancreaticoduodenectomy for other benign conditions.
The mortality rate for the present series was less than 1%. Perioperative complications, the majority of which were self-limited, occurred in 51% of patients. The most common complication was delayed gastric emptying. Pancreatic anastamotic leak occurred in 18% of patients and developed significantly more frequently in patients with benign diseases other than chronic pancreatitis (31% versus 8%, P < 0.05).
Among appropriately selected patients, the rates of perioperative mortality and serious morbidity are low, and concerns about mortality and morbidity should not prevent an aggressive approach to surgical resection in patients with benign disease.
外科医生常常因怀疑恶性肿瘤或因良性疾病出现症状而被要求实施胰十二指肠切除术。在过去20年里，胰十二指肠切除术后的围手术期发病率和死亡率已显著下降。作为回应，许多外科中心主张扩大胰十二指肠切除术的适应证，以纳入壶腹周围癌以外的病变。
对约翰霍普金斯医疗机构100个月内接受胰十二指肠切除术治疗良性疾病的108例患者的病历进行了回顾性研究。确定了组织病理学诊断为慢性胰腺炎的患者亚组，并与因其他良性疾病接受胰十二指肠切除术的患者进行了比较。
本系列患者的死亡率低于1%。围手术期并发症发生率为51%，其中大多数为自限性。最常见的并发症是胃排空延迟。18%的患者发生胰瘘，在慢性胰腺炎以外的良性疾病患者中更频繁发生（31%对8%，P<0.05）。
在适当选择的患者中，围手术期死亡率和严重发病率较低，对死亡率和发病率的担忧不应妨碍对良性疾病患者采取积极的手术切除方法。
