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恶性瘤瘤切除术后的术后并发症:从Whipple (RAW) 后复发研究 (RAW) 的结果
Thomas B Russell1, Peter L Labib1, Jemimah Denson1
1Department of HPB Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK.
BJS open
|November 30, 2023
概括
胰腺切除术 (PD) 的并发症很常见. 高BMI和ASA等级> II增加整体和主要发病率的风险,指导个性化患者护理以获得更好的结果.
科学领域:
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
- 临床流行病学临床流行病学
背景情况:
- 胰腺二管切除术 (PD),也称为Whipple手术,是一种复杂的手术,具有显著的相关术后发病率.
- 了解潜在的并发症和识别高风险患者对于知情同意,手术基准测试和个性化治疗策略至关重要.
- 术前风险分层可以实现有针对性的预康复和个性化治疗方案,以减轻不良后果.
研究的目的:
- 为了确定胰腺二切除术 (PD) 后所有并发症的发生率.
- 确定与整体发病率,主要发病率,术后胰腺囊 (POPF),胰腺切除术后出血 (PPH) 和90天死亡率相关的术前风险因素.
主要方法:
- 以回顾性队列研究,利用来自Whipple (RAW) 后复发 (RAW) 研究的数据,包括8个国家的29个中心的1348名患者 (2012-2015).
- 数据收集的重点是所有并发症的发病率和严重程度,并专门调查主要发病率 (Clavien-Dindo等级> IIIa),POPF,PPH和90天死亡率的风险因素.
主要成果:
- 总体发病率发生在53%的患者中,主要发病率发生在17%,POPF发生在8%,PPH发生在6%,以及术后死亡发生在4%的患者中.
- 多变量分析确定了高体重指数 (BMI),美国麻醉学会 (ASA) 级别>II和经典的惠普尔方法是增加整体发病率的重要风险因素.
- 具体来说,ASA等级> II与较高的重大发病率有关,高BMI与增加POPF风险相关.
结论:
- ASA等级> II是PD后重大发病率的重要危险因素.
- 高BMI被认为是术后胰腺囊 (POPF) 的危险因素.
- 基于BMI和ASA等因素的高风险患者的手术前识别,可以促进有针对性的预康复和个性化治疗计划,以改善手术结果.
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