Farley D R, Schwall G, Trede M
Chirurgische Klinik, Heidelberg University, Mannheim, Germany.
Br J Surg. 1996 Feb;83(2):176-9.
Significant complications continue to occur in a minority of patients undergoing pancreaticoduodenectomy; these frequently have fatal consequences. Analysis of 458 patients undergoing the Whipple procedure in this institution from 1972 to 1994 revealed that 16 patients with malignant periampullary tumours (ampullary, eight; pancreatic, seven; bile duct, one), and one patient with chronic pancreatitis subsequently required completion pancreatectomy. Postoperative difficulties after pancreaticoduodenectomy and indications for re-exploration were multifactorial: leakage (n = 8), pancreatitis (n = 7), bleeding (n = 1), and a delayed report of cancer at the margin of the pancreatic transection (n = 1). Completion pancreatectomy was often difficult (mean operating time 2.7 h, mean estimated blood loss 1897 ml). There was considerable significant postoperative morbidity (41 per cent) and mortality (24 per cent) after completion pancreatectomy. Patients who survived completion pancreatectomy lived a mean of nearly 4 years (range 4 months to 9.7 years, median 2.6 years). Tumour recurrence led to death in ten of 13 patients. Three patients remain alive and free of recurrence each more than 8 years after resection. Re-exploration and subsequent completion pancreatectomy after pancreaticoduodenectomy is rarely necessary, but if clinical manifestations occur secondary to failure of the pancreaticojejunostomy, early surgical intervention may maximize survival.
少数接受胰十二指肠切除术的患者仍会出现严重并发症，这些并发症常常会导致致命后果。对1972年至1994年在本机构接受惠普尔手术的458例患者进行分析发现，16例患有壶腹周围恶性肿瘤（壶腹癌8例、胰腺癌7例、胆管癌1例）的患者以及1例患有慢性胰腺炎的患者随后需要进行全胰切除术。胰十二指肠切除术后的困难及再次手术探查的指征是多因素的：渗漏（8例）、胰腺炎（7例）、出血（1例）以及胰腺横断缘癌症的延迟报告（1例）。全胰切除术往往难度较大（平均手术时间2.7小时，平均估计失血量1897毫升）。全胰切除术后有相当数量的显著术后发病率（41%）和死亡率（24%）。全胰切除术后存活的患者平均存活时间近4年（范围4个月至9.7年，中位数2.6年）。13例患者中有10例因肿瘤复发死亡。3例患者在切除术后8年以上仍存活且无复发。胰十二指肠切除术后很少需要再次手术探查及随后的全胰切除术，但如果因胰空肠吻合失败出现临床表现，早期手术干预可能会使生存率最大化。
