全胰切除术-指征,早期发病率和围手术期策略。36例连续患者的亲身体会及文献复习。

IF 0.8 Q4 SURGERY
Chirurgia Pub Date : 2025-08-01 DOI:10.21614/chirurgia.3171
Elena Vrabie, Mara Mardare, Mihai Eftimie, Octav Ginghina, Traian Dumitrascu
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引用次数: 0

摘要

背景/目的:全胰腺切除术(TP)是一种少见的胰腺切除术,即使在大容量中心也是如此。TP的适应症尚未完全确定,其结果也存在争议。本研究旨在评估当代36例连续患者TP的使用频率、适应症和早期结果。患者和方法:回顾性提取2017年2月1日至2024年12月31日期间由三位经验丰富的胰腺外科医生进行的所有连续选择性TP的数据,这些数据来自前瞻性维护的胰腺切除术电子数据库。我们分析了需要TP的患者的适应症、手术技术和早期结果。结果:患者以男性为主(20例,56%),中位年龄67岁(44 ~ 76岁)。胰导管腺癌为主要适应症(24例,67%)。发生TP的主要原因是多中心病变(14例,39%)、远端胰腺发育不全/萎缩(8例,22%)、高危吻合(7例,19%)和胰十二指肠切除术后胰腺边缘阳性(6例,17%)。脾切除术23例(64%),静脉和动脉切除术分别4例(11%)和2例(6%)。总体和严重(即3级Dindo)发病率分别为83%和25%,90天死亡率为6%。手术并发症的主要原因是临床相关的胃排空延迟(5例,14%)和胆漏(4例,11%)。结论:TP的适应症罕见且特殊,包括多中心肿瘤、胰腺远端萎缩、胰颈缘阳性、胰十二指肠切除术后吻合高危。在经验丰富的医生看来,对于如此复杂的外科手术,严重的发病率和死亡率是可以接受的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Total Pancreatectomy - Indications, Early Morbidity and Perioperative Strategy. Own Experience of 36 Consecutive Patients and Literature Review.

Background/ Aim: Total pancreatectomy (TP) is an uncommon type of pancreatic resection, even at high-volume centers. The indications of a TP are not fully defined, and the outcomes are controversial. The study aims to assess the frequency of use, indications, and early outcomes of TP in a contemporary consecutive series of 36 patients. Patients and Methods: The data of all consecutive elective TP performed by three experienced pancreatic surgeons between February 1, 2017, and December 31, 2024, were retrospectively extracted from a prospectively maintained electronic database of pancreatic resections. The data of patients requiring TP were analyzed for indications, surgical technique, and early outcomes. Results: The patients were predominantly males (20 patients, 56%) with a median age of 67 years (range 44-76 years). Pancreatic ductal adenocarcinoma was the main indication (24 patients, 67%). The main reasons for a TP were multicentric lesions (14 patients, 39%), distal pancreas hypoplasia/ hypotrophy (8 patients, 22%), highrisk anastomoses (7 patients, 19%), and positive pancreatic margins (6 patients, 17%) following pancreaticoduodenectomy. Splenectomy was performed in 23 patients (64%), while venous and arterial resections were performed in 4 patients (11%) and two patients (6%), respectively. Overall and severe (i.e., grade 3 Dindo) morbidity rates were 83% and 25%, respectively, with a 90-day mortality of 6%. The primary sources of surgical morbidity were clinically relevant delayed gastric emptying (5 patients, 14%) and bile leak (4 patients, 11%). Conclusions: TP has rare and specific indications, including multicentric tumors, distal pancreas hypotrophy, positive pancreatic neck margins, and high-risk anastomosis after pancreaticoduodenectomy. In experienced hands, severe morbidity and mortality rates are acceptable for such a complex surgical procedure.

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来源期刊
Chirurgia
Chirurgia Medicine-Surgery
CiteScore
1.00
自引率
0.00%
发文量
75
审稿时长
4-8 weeks
期刊介绍: Chirurgia is a bimonthly journal. In Chirurgia, original papers in the area of general surgery which neither appeared, nor were sent for publication in other periodicals, can be published. You can send original articles, new surgical techniques, or comprehensive general reports on surgical topics, clinical case presentations and, depending on publication space, - reviews of some articles of general interest to surgeons from other publications. Chirurgia is also a place for sharing information about the activity of various branches of the Romanian Society of Surgery, information on Congresses and Symposiums organized by the Romanian Society of Surgery and participation notes in other scientific meetings. Letters to the editor: Letters commenting on papers published in Chirurgia are welcomed. They should contain substantive ideas and commentaries supported by appropriate data, and should not exceed 2 pages. Please submit these letters to the editor through our online system.
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