Barnett Stephen A, Collier Neil A
Royal Melbourne Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2006 Jul;76(7):563-8. doi: 10.1111/j.1445-2197.2006.03778.x.
Whether preoperative biliary drainage (PBD) is beneficial in reducing complications after pancreaticoduodenectomy is controversial. There remains a reluctance to consider pancreaticoduodenectomy in older patients. The major source of morbidity and potential mortality after pancreaticoduodenectomy is pancreatic fistula, which is caused by difficulties associated with the pancreatic anastomosis. The purpose of this study was to examine the effect of PBD, patient age and method of pancreatico-enteric reconstruction on postoperative morbidity and mortality.
A total of 104 consecutive patients undergoing pancreaticoduodenectomy between November 1992 and November 2004 were identified from a prospectively collected database. Multiple preoperative and intraoperative variables were examined and their relationship to postoperative outcome was analysed.
Postoperative mortality was <1%. Forty-three patients (43%) suffered a total of 85 complications. Median length of stay was 12.5 days (range, 1-88 days). The group undergoing PBD did not have higher rates of infectious complication (12 vs 19%; P = 0.34) or overall complication (41 vs 42%; P = 0.88) compared with the undrained group. Rate of anastomotic leak (18 vs 4%; P = 0.045) and anaemia requiring transfusion (41 vs 9%; P = 0.001) were significantly higher in the pancreaticojejunostomy group compared with the pancreaticogastrostomy group. Patients over the age of 70 years did not have higher rates of complication (44 vs 41%, P = 0.5) or postoperative length of stay.
Preoperative biliary drainage was not associated with increased postoperative complications. Pancreaticogastrostomy after pancreaticoduodenectomy is a safe and reliable method of reconstruction. Finally, pancreaticoduodenectomy can be carried out with acceptable rates of postoperative morbidity and mortality in selected patients over 70 years of age.
术前胆道引流（PBD）在降低胰十二指肠切除术后并发症方面是否有益存在争议。老年患者仍不愿考虑接受胰十二指肠切除术。胰十二指肠切除术后发病和潜在死亡的主要原因是胰瘘，这是由胰肠吻合相关的困难所致。本研究的目的是探讨PBD、患者年龄和胰肠重建方法对术后发病率和死亡率的影响。
从一个前瞻性收集的数据库中确定了1992年11月至2004年11月期间连续接受胰十二指肠切除术的104例患者。检查了多个术前和术中变量，并分析了它们与术后结果的关系。
术后死亡率<1%。43例患者（43%）共出现85种并发症。中位住院时间为12.5天（范围1 - 88天）。与未行引流的组相比，接受PBD的组感染性并发症发生率（12%对19%；P = 0.34）或总体并发症发生率（41%对42%；P = 0.88）并无更高。与胰胃吻合术组相比，胰空肠吻合术组吻合口漏发生率（18%对4%；P = 0.045）和需要输血的贫血发生率（41%对9%；P = 0.001）显著更高。70岁以上患者的并发症发生率（44%对41%，P = 0.5）或术后住院时间并无更高。
术前胆道引流与术后并发症增加无关。胰十二指肠切除术后胰胃吻合术是一种安全可靠的重建方法。最后，对于选定的70岁以上患者，实施胰十二指肠切除术的术后发病率和死亡率在可接受范围内。
