胰腺肿瘤患者的胰腺中央或远端切除术:短期疗效评估

T. Mirzaev, D. V. Podluzhniy, R. Izrailov, A. Kotelnikov, E. Glukhov, I.  M. Faynshteyn, P. A. Kerimov, N. Kudashkin, A. N. Polyakov, B. I. Sakibov
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摘要

目的:比较胰中央切除术(CP)和胰远端切除术(DP)患者术后的短期和长期并发症。材料和方法。这项回顾性研究包括因胰腺良性肿瘤和低恶性潜能肿瘤而患有CP的患者(例)和因类似原因而患有DP的患者(对照组)。对照组是随机选择的,并根据肿瘤大小、糖尿病(Dm)的存在和ASA的身体状况匹配病例。我们评估了术后晚期≥III级并发症(Clavien-Dindo分类)、临床显著的胰瘘、Dm和胰腺外分泌功能受损的发生率。后果有25例病例和25例对照。两组患者的主要临床特征相匹配。CP组的手术时间明显长于DP组(230分钟vs 180分钟,р<0.0001)。术后并发症的总发生率没有差异(9(36%)vs 14(56%),р=0.26);CP组有术后并发症发生率增高的趋势。两名CP患者(8%)需要重复手术。研究参与者中没有一人死亡。分别有8名(32%)和11名(44%)患者出现具有临床意义的(B和C)胰腺瘘(p=0.56)。DP组中有两名患者(8%)出现胰腺外分泌功能损伤,需要药物治疗。术后无一例出现Dm。结论尽管CP和DP结果在评估的主要参数方面具有可比性,但严重的CP后并发症表明,需要仔细选择患者进行此类干预并进一步积累经验。我们的研究结果可用于随后对不同诊所经验的分析。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Central or distal pancreatectomy in patients with pancreatic tumors: assessment of short‑term outcomes
Objective: to compare short-term and long-term postoperative complications between patients who have undergone central pancreatectomy (CP) and distal pancreatectomy (DP).Materials and methods. This retrospective study included patients who had CP for benign pancreatic tumors and tumors of low malignant potential (cases) and patients who had DP for similar reasons (controls). The controls were randomly selected and matched cases for tumor size, presence of diabetes mellitus (Dm), and ASA physical status. we evaluated the incidence of grade ≥III complications (Clavien–Dindo classification), clinically significant pancreatic fistulas, Dm, and impaired exocrine pancreatic function in the late postoperative period.Results. There were 25 cases and 25 controls. Both groups were matched for the main clinical characteristics. Surgeries were significantly longer in the CP groups compared to the DP group (230 min vs 180 min, р < 0.0001). There was no difference in the overall incidence of postoperative complications (9 (36 %) vs 14 (56 %), р = 0.26); there was a trend towards a higher incidence of postoperative complications in the CP group. Two patients after CP (8 %) required repeated surgeries. none of the study participants died. Clinically significant (B and C) pancreatic fistulas were registered in 8 (32 %) and 11 (44 %) patients, respectively (p = 0.56). Two patients in the DP group (8 %) developed impairments of exocrine pancreatic function that required pharmacotherapy. none of the patients developed Dm postoperatively.Conclusion. Despite the fact that CP and DP outcomes were comparable in terms of the main parameters evaluated, severe post-CP complications indicate that there is a need for careful selection of patients for such interventions and further accumulation of experience. Our findings can be used in the subsequent analysis of the experience of different clinics.
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