在胰腺切除术期间完成胰腺切除术:高危患者的救生解决方案
Antoine Ailhaud1,2, Edouard Girard1,2, Joey Fournier3
1University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC, Grenoble, France.
World journal of surgery
|March 30, 2024
概括
整体胰腺切除术 (TP) 可以通过减少术后胰腺 (POPF) 等并发症来改善胰腺手术的高风险患者的结果. 使用TP的风险量身定制策略显著降低了重新手术,POPF,出血和死亡率.
科学领域:
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
- 临床结果研究研究
背景情况:
- 手术后的胰腺 (POPF) 是胰腺双管切除术 (PD) 后发病和死亡的主要原因.
- 总胰腺切除术 (TP) 可能通过潜在地避免高风险个体的POPF提供更好的结果.
- 在高危患者中评估TP与PD对于优化外科手术策略至关重要.
研究的目的:
- 为了比较高风险患者的全胰腺切除术 (TP) 和胰腺二切除术 (PD) 的结果.
- 评估在胰腺手术的临床实践中实施风险量身定制策略的有效性.
- 为了减少与胰腺切除相关的严重并发症和死亡率.
主要方法:
- 在2014年至2023年期间,对139名接受胰腺头切除的患者进行了回顾性分析.
- 从2022年1月起实施针对风险量身定制的战略,为高POPF风险 (FRS ≥7) 或中等风险 (FRS 3-6) 和高失败救援风险 (年龄>75,ASA ≥3) 的患者提供TP.
- 基于倾向性得分的分析,以比较TP和PD组之间的结果,并评估战略的影响.
主要成果:
- 在139名患者中,26名 (19%) 接受了TP,113名 (81%) 接受了PD. 严重的并发症发生在30%的患者中,死亡率为9%.
- 与PD相比,TP与更短的住院时间 (14 vs. 17天,p=0.016) 和显著较低的胰腺切除术后出血率 (PPH) (0% vs. 20%,p<0.001) 相关.
- 根据风险量身定制的策略显著降低了重新操作,POPF,PPH和死亡率.
结论:
- 全胰腺切除术,当在风险量身定制的策略中使用时,可以成为高风险手术患者的救生选择.
- 实施一种基于风险因素选择患者接受手术治疗的策略,可以改善手术结果.
- 这种方法有助于减轻胰腺手术后的严重并发症和死亡率.
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