원위부 췌장 절제술에서 이환율 및 사망률에 관여하는 인자
Factors Associated with Morbidity and Mortality in Distal Pancreatectomy
유영동, 한형준, 김종만, 김완배, 엄준원, 목영재, 최상룡, 김영철,
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유영동 ( Yu Young-Dong )
고려대학교 의과대학 외과학교실
한형준 ( Han Hyung-Joon )
고려대학교 의과대학 외과학교실
김종만 ( Kim Jong-Man )
고려대학교 의과대학 외과학교실
김완배 ( Kim Wan-Bae )
고려대학교 의과대학 외과학교실
엄준원 ( Um Jun-Won )
고려대학교 의과대학 외과학교실
목영재 ( Mok Young-Jae )
고려대학교 의과대학 외과학교실
최상룡 ( Choi Sang-Yong )
고려대학교 의과대학 외과학교실
김영철 ( Kim Young-Chul )
고려대학교 의과대학 외과학교실
KMID : 0371320040670030208
Abstract
PURPOSE: A pancreatic leak is a major source of morbidity associated with pancreatic surgery. A review of the indication for distal pancreatectomy and the disease and technique dependent factors associated with morbidity and mortality after this procedure were sought.
METHODS: A retrospective analysis of the hospital records of all patients having undergone a distal pancreatectomy between January 1998 and December 2002 was prformed. The clinical, technical and pathological data were correlated with the operative morbidity or mortality.
RESULTS: 95 patients had undergone a distal pancreatectomy. The male to female ratio of our series was 2.3 to 1, with a mean age of 54.2 years. 38 patients underwent the distal pancreatectomy for an intrapancreatic disease and 57 for an extrapancreatic disease, with a curative resection for stomach cancer the most common indication (47.4%). The clinicopathological and technical factors included the urgency of the operation, presence or absence of malignancy in the resected pancreas, method of pancreatic stump closure (suture vs. stapled) and the presence of a concomitant splenectomy. The morbidity and mortality rates were 27.3 and 2%, respectively. The postoperative complications included pancreatic fistula, intraabdominal abscess and wound infection among others. There were no factors significantly associated with the development of postoperative complications, especially pancreatic leakage.
CONCLUSION: A distal pancreatectomy can be performed for a variety of benign and malignant conditions, with a low rate of mortality, although a pancreatic leak can be a serious cause of morbidity. The morbidity and pancreatic leakage rates in our study were 27.3 and 9.4%, respectively, but as there were no clinical or technical factors associated with pancreatic leakage in this retrospective analysis, it is propose that a prospective trial should be performed.
키워드
원위부 췌장 절제술; 합병증; 사망률; Distal pancreatectomy; Complication; Mortality
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