Reappraisal of post-pancreatectomy hemorrhage (PPH) classifications: do we need to redefine grades A and B?

被引:26
作者
Duarte Garces, Alvaro A. [1 ,2 ]
Andrianello, Stefano [2 ]
Marchegiani, Giovanni [2 ]
Piccolo, Roberta [2 ]
Secchettin, Erica [2 ]
Paiella, Salvatore [2 ]
Malleo, Giuseppe [2 ]
Salvia, Roberto [2 ]
Bassi, Claudio [2 ]
机构
[1] Hosp Pablo Tobon Uribe, Dept Cirugia Hepato Biliar & Pancreat, Medellin, Colombia
[2] Univ Verona Hosp Trust, Pancreas Inst, Gen & Pancreat Surg, Verona, Italy
关键词
INTERNATIONAL STUDY-GROUP; PANCREATIC SURGERY ISGPS; POSTOPERATIVE HEMORRHAGE; DEFINITION; PANCREATICODUODENECTOMY; EXPERIENCE; MANAGEMENT; FISTULA;
D O I
10.1016/j.hpb.2018.01.013
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Post-pancreatectomy hemorrhage (PPH) remains a major complication. The aim of this study was to reappraise the International Study Group of Pancreatic Surgery (ISGPS) classification. Methods: The clinical utility of the ISGPS classification was tested on consecutive pancreatic resections performed at the Pancreas Institute of the University of Verona Hospital. Results: PPH occurred in 65 of the 2429 patients (6.8%) undergoing pancreatic resection. Outcome of patients without PPH and with grade A PPH were comparable in terms of mortality, length of stay, ICU stay and readmission. Patients with grade B late and mild and grade B early and severe PPH had similar hospital stay and mortality rates, but differed in relaparotomy rate (10.1 vs. 81.2%, p < 0.01). Replacing " time of PPH onset" criterion with post-operative pancreatic fistula (POPF), severe PPH alone, mild PPH/POPF and severe PPH/POPF differed significantly for hospital stay (14 vs. 23 vs. 35 days, p < 0.01) and mortality rate (0 vs. 4 vs. 25%, p = 0.05). Conclusion: Grade A PPH shared the same outcome of patients without PPH. Grade B PPH included two categories of patients with different treatment modalities. The use of "concomitant POPF" instead of " time of onset" segregated three discrete categories that differed significantly in terms of clinical outcomes and management.
引用
收藏
页码:702 / 707
页数:6
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