Sauvanet A, Belghiti J
Service de Chirurgie Digestive, Hôpital Beaujon, Clichy.
Ann Chir. 1999;53(7):612-7.
A pancreatic fistula occurs in about 10% of cases after Whipple's procedure. This complication is associated with a mortality rate ranging from 7% to 30%. The main predisposing factor of pancreatic fistula is a soft pancreatic parenchyma. Several procedures have been proposed to decrease the rate of this complication. Occlusion of the residual stump is infrequently used and does not clearly reduce the rate of this complication. Pancreaticojejunostomy is the technique most frequently used. No alternative technique is clearly superior to pancreaticojejunostomy. Pancreaticogastrostomy and pancreaticojejunostomy have equivalent early results. Superiority of transient intubation of the Wirsung duct and mucosa-to-mucosa anastomosis is not demonstrated. Among the 7 controlled randomized studies which tested somatostatin or its analogs, many have methodological insufficiencies which prevent definite conclusions. Meanwhile, most studies suggest that these drugs decrease the rate of pancreatic fistula after pancreaticoduodenectomy. Further evaluation in high-risk patients (soft pancreatic parenchyma) is advisable.
胰瘘在惠普尔手术后约10%的病例中出现。这种并发症的死亡率在7%至30%之间。胰瘘的主要诱发因素是胰腺实质柔软。已经提出了几种手术方法来降低这种并发症的发生率。残端闭塞很少使用，且不能明显降低这种并发症的发生率。胰空肠吻合术是最常用的技术。没有其他替代技术明显优于胰空肠吻合术。胰胃吻合术和胰空肠吻合术的早期结果相当。未证实威尔松管短暂插管和黏膜对黏膜吻合术的优越性。在7项测试生长抑素或其类似物的对照随机研究中，许多研究存在方法学上的不足，无法得出明确结论。同时，大多数研究表明，这些药物可降低胰十二指肠切除术后胰瘘的发生率。建议对高危患者（胰腺实质柔软）进行进一步评估。
