Mathur Abhishek, Pitt Henry A, Marine Megan, Saxena Romil, Schmidt C Max, Howard Thomas J, Nakeeb Attila, Zyromski Nicholas J, Lillemoe Keith D
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Ann Surg. 2007 Dec;246(6):1058-64. doi: 10.1097/SLA.0b013e31814a6906.
To determine whether patients who develop a pancreatic fistula after pancreatoduodenectomy are more likely to have pancreatic fat than matched controls.
Pancreatic fistula continues to be a major cause of postoperative morbidity and increased length of stay after pancreatoduodenectomy. Factors associated with postoperative pancreatic fistula include a soft pancreas, a small pancreatic duct, the underlying pancreatic pathology, the regional blood supply, and surgeon's experience. Fatty pancreas previously has not been considered as a contributing factor in the development of postoperative pancreatic fistula.
Forty patients with and without a pancreatic fistula were identified from an Indiana University database of over 1000 patients undergoing pancreatoduodenectomy and matched for multiple parameters including age, gender, pancreatic pathology, surgeon, and type of operation. Surgical pathology specimens from the pancreatic neck were reviewed blindly for fat, fibrosis, vessel density, and inflammation. These parameters were scored (0-4+).
The pancreatic fistula patients were less likely (P < 0.05) to have diabetes but had significantly more intralobular (P < 0.001), interlobular (P < 0.05), and total pancreatic fat (P < 0.001). Fistula patients were more likely to have high pancreatic fat scores (50% vs. 13%, P < 0.001). Pancreatic fibrosis, vessel density, and duct size were lower (P < 0.001) in the fistula patients and negative correlations (P < 0.001) existed between fat and fibrosis (R = -0.40) and blood vessel density (R = -0.15).
These data suggest that patients with postoperative pancreatic fistula have (1) increased pancreatic fat and (2) decreased pancreatic fibrosis, blood vessel density, and duct size. Therefore, we conclude that fatty pancreas is a risk factor for postoperative pancreatic fistula.
确定胰十二指肠切除术后发生胰瘘的患者比匹配的对照组更易出现胰腺脂肪的情况。
胰瘘仍然是胰十二指肠切除术后发病的主要原因以及住院时间延长的原因。与术后胰瘘相关的因素包括胰腺质地柔软、胰管细小、潜在的胰腺病变、局部血供以及外科医生的经验。胰腺脂肪此前未被视为术后胰瘘发生的一个促成因素。
从印第安纳大学超过1000例行胰十二指肠切除术患者的数据库中识别出40例有或无胰瘘的患者，并在年龄、性别、胰腺病变、外科医生及手术类型等多个参数上进行匹配。对胰腺颈部的手术病理标本进行盲法检查，以评估脂肪、纤维化、血管密度和炎症情况。这些参数进行评分（0 - 4+）。
胰瘘患者患糖尿病的可能性较小（P < 0.05），但小叶内（P < 0.001）、小叶间（P < 0.05）及胰腺总脂肪量显著更多（P < 0.001）。胰瘘患者更易出现高胰腺脂肪评分（50% 对13%，P < 0.001）。胰瘘患者的胰腺纤维化、血管密度和胰管大小较低（P < 0.001），且脂肪与纤维化（R = -0.40）及血管密度（R = -0.15）之间存在负相关（P < 0.001）。
这些数据表明，术后胰瘘患者有（1）胰腺脂肪增加和（2）胰腺纤维化、血管密度及胰管大小降低的情况。因此，我们得出结论，胰腺脂肪是术后胰瘘的一个危险因素。
