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Abstract：
Introduction: Patients with chronic pancreatitis (CP) as well as with pancreatic head carcinoma (CA) undergo the surgical intervention named \"pylorus-preserving pancreatoduodenectomy according to Traverso-Longmire (PPPD)\", which allowed a comparative analysis of the postoperative courses. The hypothesis was that patients with CA would have worse general as well as immune status than patients with CP due to the severity of the tumor disease and that this would be reflected in the more disadvantageous early postoperative outcome after PPPD. Methods: With the aim of eliciting the influence of the different diagnoses, the surgical outcome of all consecutive patients who underwent surgery at the Dept. of General, Abdominal, Vascular and Transplant Surgery at the University Hospital at Magdeburg between 2002 and 2015 (inclusion criterion) was recorded and comparatively evaluated. Early postoperative outcome was characterized by general and specific complication rate indicating morbidity, mortality, and microbial colonization rate, in particular surgical site infection (SSI, according to CDC criteria). In addition, microbiological findings of swabs and cultures from all compartments as well as preoperative and perioperative parameters from patient records were retrospectively documented and used for statistical comparison in this systematic retrospective unicenter observational study (design). Results: In total, 192 cases with CA (68.1%) and 90 cases with CP (31.9%) met the inclusion criteria of this study. Surprisingly, there were similar specific complication rates of 45.3% (CA) vs. 45.6% (CP; p = 0.97) and in-hospital mortality, which differed only slightly at 3.65% (CA) vs. 3.3% (CP; p = 0.591); the overall complication rate tended to be higher for CA at 23.4% vs. 14.4% (CP; p = 0.082). Overall, potentially pathogenic germs were detected in 28.9% of all patients in CP compared to 32.8% in CA (p = 0.509), and the rate of SSI was 29.7% (CA) and 24.4% (CP; p = 0.361). In multivariate analysis, CA was found to be a significant risk factor for the development of SSI (OR: 2.025; p = 0.048); the underlying disease had otherwise no significant effect on early postoperative outcome. Significant risk factors in the multivariate analysis were also male sex for SSI and microbial colonization, and intraoperatively transfused red cell packs for mortality, general and specific complications, and surgical revisions. Conclusions: Based on these results, a partly significant, partly trending negative influence of the underlying disease CA, compared to CP, on the early postoperative outcome was found, especially with regard to SSI after PPPD. This influence is corroborated by the international literature.
摘要：
简介：慢性胰腺炎（CP）以及胰头癌（CA）的患者接受了名为“根据Traverso-Longmire（PPPD）保留幽门的胰十二指肠切除术”的手术干预，这允许对术后疗程进行比较分析。假设是，由于肿瘤疾病的严重程度，CA患者的一般状况和免疫状况将比CP患者更差，这将反映在PPPD后更不利的早期术后结果中。方法：为了引起不同诊断的影响，在部门接受手术的所有连续患者的手术结果。将军，腹部,记录2002年至2015年在马格德堡大学医院进行的血管和移植手术（纳入标准）并进行比较评估。术后早期结局以一般和特定并发症发生率为特征，表明发病率。死亡率,和微生物定植率，特别是手术部位感染(SSI，根据CDC标准)。此外,回顾性记录了来自所有隔室的拭子和培养物的微生物学发现以及来自患者记录的术前和围手术期参数,并用于本系统回顾性单中心观察性研究(设计)的统计学比较.结果：总的来说，192例CA(68.1%)和90例CP(31.9%)符合本研究的纳入标准。令人惊讶的是,有相似的具体并发症发生率45.3％（CA）与45.6%（CP；p=0.97）和住院死亡率，只有3.65%(CA)与3.3%（CP；p=0.591）；CA的总并发症发生率往往较高，为23.4%。14.4%（CP；p=0.082）。总的来说,在所有患者中，在CP中检测到28.9%的潜在致病细菌，而在CA中检测到32.8%(p=0.509)，SSI发生率分别为29.7%(CA)和24.4%(CP;p=0.361)。在多变量分析中，发现CA是发生SSI的重要危险因素（OR：2.025；p=0.048）；否则，潜在疾病对术后早期结果没有显着影响。多变量分析中的重要危险因素也是男性SSI和微生物定植，术中输注红细胞包死亡，一般和特定的并发症，和手术修正。结论：基于这些结果，部分意义重大，潜在疾病CA的部分趋势负面影响，相比CP,对术后早期结果的发现，尤其是PPPD后的SSI。国际文献证实了这种影响。
