医学
胰十二指肠切除术
地塞米松
围手术期
麻醉
外科
普通外科
内科学
切除术
作者
Haoda Chen,Ying Wang,Kuirong Jiang,Zhiwei Xu,Jun Yu,Zhichong Wu,Xin-Jiang Lu,Chao Wang,Yiwu Weng,Weishen Wang,Ruchuang Ding,S. Lilly Zheng,Yilong Li,Xu Fang,Guodong Shi,Jiancheng Wang,Hao Chen,Chenghong Peng,Xiaxing Deng,Yudong Qiu,Yan Luo,Bo Sun,Baiyong Shen
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2024-02-22
标识
DOI:10.1097/sla.0000000000006240
摘要
Objective: This study aimed to evaluate the effect of perioperative dexamethasone on postoperative complications after pancreaticoduodenectomy. Background: The glucocorticoid dexamethasone has been shown to improve postoperative outcomes in surgical patients, but its effects on postoperative complications after pancreaticoduodenectomy are unclear. Methods: This multicenter, double-blind, randomized controlled trial was conducted in four Chinese high-volume pancreatic centers. Adults undergoing elective pancreaticoduodenectomy were randomized to receive either 0.2 mg/kg dexamethasone or a saline placebo as an intravenous bolus within 5 minutes after anesthesia induction. The primary outcome was the Comprehensive Complication Index (CCI) score within 30 days after the operation, analyzed using the modified intention-to-treat principle. Results: Among 428 patients for eligibility, 300 participants were randomized and 265 were included in the modified intention-to-treat analyses. 134 patients received dexamethasone and 131 patients received a placebo. The mean (SD) CCI score was 14.0 (17.5) in the dexamethasone group and 17.9 (20.3) in the placebo group (mean difference, −3.8; 95% CI, −8.4 to 0.7; P =0.100). The incidence of major complications (Clavien-Dindo grade ≥III) (12.7% vs. 16.0%, risk ratio 0.79; 95% CI, 0.44 to 1.43; P =0.439) and postoperative pancreatic fistula (25.4% vs. 31.3%, risk ratio 0.81; 95% CI, 0.55 to 1.19; P =0.286) were not significantly different between the two groups. In the stratum of participants with a main pancreatic duct ≤3 mm (n=202), the CCI score was significantly lower in the dexamethasone group (mean difference, -6.4; 95% CI, −11.2 to −1.6; P =0.009). Conclusion: Perioperative dexamethasone did not significantly reduce postoperative complications within 30 days after pancreaticoduodenectomy.
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