Hosotani Ryo, Doi Ryuichiro, Imamura Masayuki
Department of Surgery and Surgical Basic Science, Kyoto University Graduate School of Medicine, 54-Shogoin Kawaracyo, Sakyo, Kyoto 606-8507, Japan.
World J Surg. 2002 Jan;26(1):99-104. doi: 10.1007/s00268-001-0188-z. Epub 2001 Nov 26.
The aim of this retrospective study was to analyze the risk factors for pancreatic anastomotic leakage after pancreatoduodenectomy (PD) and to determine whether duct-to-mucosa pancreaticojejunostomy is superior to the total external tube drainage technique. Between 1990 and 1999, 161 patients underwent PD with end-to-side pancreaticojejunostomy at our institution. Fourteen preoperative and ten intraoperative risk factors for pancreaticojejunal anastomotic leakage were analyzed. Pancreaticojejunal anastomotic leakage was identified in 11% (17/161) of the patients. No preoperative parameters were found to have a significant association with the risk of pancreatic leakage. Three intraoperative parameters were identified as significant by means of univariate analysis: anastomotic technique, pancreatic duct size and texture of the remnant pancreas. A duct-to-mucosa pancreaticojejunostomy with total external tube drainage (3% vs. 15%, p = 0.018). A pancreas without duct dilatation of soft pancreas was more likely to develop pancreatic leakage than one with duct dilatation or atrophy. A multivariate analysis revealed that only anastomotic technique turned out to be an independent risk factor (Odds ratio: 4.15, CI: 1.1-27.4). Sub-analysis of patients with soft pancreas and non-dilated pancreatic duct further supported the finding that the duct-to-mucosa pancreaticojejunostomy technique is safer for patients at high risk. Results indicate that the status of the remnant pancreas and the pancreaticojejunostomy technique are the substantial risk factors for pancreatic leakage after pancreatoduodenecomy. Duct-to-mucosa pancreaticojejunostomy might well be the procedure of choice.
这项回顾性研究的目的是分析胰十二指肠切除术（PD）后胰肠吻合口漏的危险因素，并确定黏膜对黏膜胰肠吻合术是否优于全外引流技术。1990年至1999年间，我院161例患者接受了端侧胰肠吻合的PD手术。分析了14个术前和10个术中胰肠吻合口漏的危险因素。11%（17/161）的患者出现了胰肠吻合口漏。未发现术前参数与胰漏风险有显著相关性。单因素分析确定了三个术中参数具有显著性：吻合技术、胰管大小和残余胰腺质地。采用全外引流的黏膜对黏膜胰肠吻合术（3%对15%，p = 0.018）。与胰管扩张或萎缩的胰腺相比，无胰管扩张的软胰腺更易发生胰漏。多因素分析显示，只有吻合技术是独立的危险因素（比值比：4.15，可信区间：1.1 - 27.4）。对软胰腺和胰管未扩张患者的亚组分析进一步支持了以下发现，即黏膜对黏膜胰肠吻合术对高危患者更安全。结果表明，残余胰腺状态和胰肠吻合技术是胰十二指肠切除术后胰漏的主要危险因素。黏膜对黏膜胰肠吻合术很可能是首选术式。
