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Medline ® Abstract for Reference 32

of '全胰切除术'

Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy: early and late outcome.
Gueroult S, Parc Y, Duron F, Paye F, Parc R
Arch Surg. 2004 Jan;139(1):16-9.
HYPOTHESIS: Completion pancreatectomy in patients with pancreatic leakage associated with postoperative peritonitis after pancreaticoduodenectomy is a viable salvage procedure.
DESIGN: Retrospective analysis from a cohort of consecutive patients admitted between January 1, 1989, and December 31, 1999, for postoperative peritonitis originating from pancreaticojejunostomy leakage.
SETTING: Tertiary referral center with surgical intensive care unit specializing in the treatment of intra-abdominal sepsis.
PATIENTS: Eight consecutive patients with postoperative peritonitis originating from pancreaticojejunostomy after pancreaticoduodenectomy, with a mean Acute Physiology and Chronic Health Evaluation II score of 18.6. We excluded patients with pancreatic fistulas or abscesses amenable to percutaneous drainage or other conservative treatment.
INTERVENTION: Completion pancreatectomy.
MAIN OUTCOME MEASURES: Mortality, morbidity, and long-term outcome, which was assessed by interview.
RESULTS: Three patients died in the postoperative period: 2 required early reoperation during the postoperative period and died of hemorrhage and sepsis, and 1 died of multiorgan failure without reoperation. Recurrence of carcinoma was responsible for late death of 2 other patients.
CONCLUSIONS: Postoperative peritonitis after pancreaticoduodenectomy still has high mortality; however, completion pancreatectomy may represent the only means to achieve source control of infection in cases of postoperative peritonitis.
Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique/Hôpitaux de Paris, UniversitéPierre et Marie Curie, Paris, France.