Shan Yan-Shen, Sy Edgar D, Lin Pin-Wen
Department of Surgery, Division of General Surgery, and Institution of Clinica Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, Taiwan.
World J Surg. 2003 Jun;27(6):709-14. doi: 10.1007/s00268-003-6693-5. Epub 2003 May 13.
A prospective, randomized, controlled trial was performed to determine the efficacy of somatostatin in the prevention of pancreatic stump-related complications with elimination of surgeon-related factors in high-risk patients undergoing pancreaticoduodenectomy. From August 1997 to December 2000, 54 patients, 28 men and 26 women, with age ranged from 32 to 89 years, were randomly assigned to somatostatin group ( n = 27) or placebo group ( n = 27). Ninety-four percent of the patients had pancreatic and periampullary lesions; 6% had secondary lesion involving the duodenum such as local recurrent colon carcinoma and renal cell carcinoma. These patients received either standard pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy. An experienced surgeon performed all operations in same fashion to minimize the surgical factor. A transanastomotic tube was inserted into the pancreatic duct for diversion of pancreatic juice in the pancreaticojejunostomy for a 3-weeks period postoperatively. Intravenous infusion of somatostatin was given at a dose of 250 microg/hr in the somastotatin group and normal saline was given to the control group for 7 days postoperatively. There was one perioperative death in each group, resulting in a 3.7% mortality rate. In the somastotatin group, as compared to the placebo group, the incidence of overall morbidity and pancreatic stump related complications were significantly lower with a mean decrease of 50% pancreatic juice output and a slightly shorter duration of hospital stays. In conclusion, after excluding surgeon related factor, prophylactic use of somatostatin reduces the incidence and severity of pancreatic stump related complications in high-risk patients having pancreaticoduodenectomy via decreased secretion of pancreatic exocrine.
进行了一项前瞻性、随机、对照试验，以确定在接受胰十二指肠切除术的高危患者中，消除外科医生相关因素后，生长抑素预防胰腺残端相关并发症的疗效。1997年8月至2000年12月，54例患者（28例男性和26例女性，年龄32至89岁）被随机分为生长抑素组（n = 27）或安慰剂组（n = 27）。94%的患者患有胰腺和壶腹周围病变；6%有累及十二指肠的继发性病变，如局部复发性结肠癌和肾细胞癌。这些患者接受标准胰十二指肠切除术或保留幽门的胰十二指肠切除术。由一名经验丰富的外科医生以相同方式进行所有手术，以尽量减少手术因素。在胰肠吻合术中，将一根经吻合口的导管插入胰管，用于术后3周引流胰液。生长抑素组术后7天以250微克/小时的剂量静脉输注生长抑素，对照组输注生理盐水。每组各有1例围手术期死亡，死亡率为3.7%。与安慰剂组相比，生长抑素组的总体发病率和胰腺残端相关并发症的发生率显著降低，胰液分泌平均减少50%，住院时间略短。总之，在排除外科医生相关因素后，预防性使用生长抑素可通过减少胰腺外分泌，降低高危胰十二指肠切除患者胰腺残端相关并发症的发生率和严重程度。
