Bartoli F G, Arnone G B, Ravera G, Bachi V
Department of Surgery, University of Genoa, Italy.
Anticancer Res. 1991 Sep-Oct;11(5):1831-48.
This paper analysed the literature published in the last 15 years regarding the onset of pancreatic fistula after pancreaticoduodenectony carried out for tumours in the periampullary region, in the head of the pancreas and in the distal common bile duct. Out of 8370 pancreatic resections we were able to go by only 2684 cases, which showed the type of treatment used in the remaining stump, the rates of leakage and relative mortality. The data collected were analysed statistically using the Cochran test and or the chi 2, evaluating the possible significant difference relative to the various methods of reconstruction. The onset of pancreatic fistrula was found to be statistically more frequent after ligation of the stump than after pancreatico-jejunal anastomosis (p = 0.001). Comparing the pancreatico-jejunal end-to-side anastomosis, to pancreatico-jejunal end-to-end and wirsung-jejunal end-to-side anastomosis the first one had shown a significantly higher rate only for leakage (respectively p = 0.008 and p = 0.010). The occlusion of the wirsung duct with biological substances showed better results compared to ligation (p = 0.001) only as regards onset of the fistula, while the comparison between the occlusion and the three types of anastomosis did not show any statistically difference, except for the pancreatico-jejunal end-to-side anastomosis, in which it was significant only as regards leakage (p = 0.009). The statistical analysis between pancreatico-gastrostomy and pancreatico-jejunal anastomoses indicated that the first technique had a lower morbidity rate than pancreatico-jejunal end-to-side (p = 0.001), pancreatico-jejunal end-to-end (p = 0.010) and wirsung-jejunal end-to-side (p = 0.011). We analysed and compared the results obtained before and after 1975, in order to discover whether was an improvement in the prevnetion or in the treatment of such a complication and its consequences. Furthermore, we tried to establish whether the transanastomotic drainage, the site of the neoplasm, the texture of pancreatic parenchyma and the patient's age could in any way influence the onset and course of the fistula.
本文分析了过去15年发表的关于在壶腹周围区域、胰头和胆总管远端进行肿瘤胰十二指肠切除术后胰瘘发生情况的文献。在8370例胰腺切除术中，我们仅能获取2684例病例的信息，这些病例显示了残端所采用的治疗方式、渗漏率和相对死亡率。使用 Cochr an检验和卡方检验对收集到的数据进行统计学分析，评估相对于各种重建方法可能存在的显著差异。结果发现，残端结扎后胰瘘的发生在统计学上比胰空肠吻合术后更为频繁（p = 0.001）。将胰空肠端侧吻合术与胰空肠端端吻合术以及胰管空肠端侧吻合术进行比较，仅在渗漏方面，前者显示出显著更高的发生率（分别为p = 0.008和p = 0.010）。与结扎相比，使用生物物质阻塞胰管仅在胰瘘发生方面显示出更好的结果（p = 0.001），而阻塞与三种吻合术之间的比较未显示出任何统计学差异，但胰空肠端侧吻合术除外，在该吻合术中仅在渗漏方面具有显著性（p = 0.009）。胰胃吻合术与胰空肠吻合术之间的统计学分析表明，第一种技术的发病率低于胰空肠端侧吻合术（p = 0.001）、胰空肠端端吻合术（p = 0.010）和胰管空肠端侧吻合术（p = 0.011）。我们分析并比较了1975年前后获得的结果，以发现预防或治疗这种并发症及其后果方面是否有改善。此外，我们试图确定经吻合口引流、肿瘤部位、胰腺实质质地和患者年龄是否会以任何方式影响瘘的发生和病程。
