Kollmar O, Moussavian M R, Richter S, de Roi P, Maurer C A, Schilling M K
Department of General, Visceral, Vascular and Pediatric Surgery, Kirrbergerstr, University of Saarland, D-66421 Homburg/Saar, Germany.
Department of Surgery, Hospital of Liestal, CH-4410 Liestal, Switzerland.
Eur J Surg Oncol. 2008 Aug;34(8):868-875. doi: 10.1016/j.ejso.2008.01.014. Epub 2008 Mar 4.
To evaluate the impact of prophylactic octreotide on gastric emptying in patients undergoing pancreaticoduodenectomy. Postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE) are common complications after pancreaticoduodenectomy. Whereas several prospective randomized trials propose the prophylactic use of octreotide to prevent pancreatic fistula formation, somatostatin has, however, been associated with delayed gastric emptying after partial duodenopancreatectomy.
In this prospective, randomized, double-blinded, placebo-controlled trial we analyzed the influence of prophylactic octreotide on delayed gastric empting after pancreaticoduodenectomy. Patients were randomized to the placebo group (n=32) and the octreotide group (n=35). Primary endpoint was the incidence of delayed gastric emptying, secondary endpoints included perioperative morbidity other than DGE. DGE was measured by clinical signs, gastric scintigraphy and the hydrogen breath test. Risk factors for DGE other than octreotide were analyzed by univariate and multivariate analyses.
DGE measured by clinical signs was similar between both groups studied ( approximately 20% of the patients). Gastric scintigraphy (T(1/2)) was 76.3+/-15.2 min in the octreotide group and 86.7+/-18.0 min in controls at day 7, respectively. The H(2) breath test was 65.0+/-6.5 min in octreotide treatment group and 67.0+/-5.7 min in controls at day 8. POPF grade C occurred in approximately 3% of the patients, although prophylactic treatment of octreotide did not reduce the incidence of POPF. Multivariate analysis showed that postoperative intraabdominal bleeding and infection were independent risk factors for DGE. Furthermore preoperative biliary stenting reduced postoperative DGE after partial duodenopancreatectomy.
Prophylactic octreotide has no influence on gastric emptying and does not decrease the incidence of postoperative pancreatic fistula after pancreaticoduodenectomy.
评估预防性使用奥曲肽对接受胰十二指肠切除术患者胃排空的影响。术后胰瘘（POPF）和胃排空延迟（DGE）是胰十二指肠切除术后常见的并发症。尽管多项前瞻性随机试验提出预防性使用奥曲肽以预防胰瘘形成，但生长抑素与部分十二指肠胰腺切除术后胃排空延迟有关。
在这项前瞻性、随机、双盲、安慰剂对照试验中，我们分析了预防性使用奥曲肽对胰十二指肠切除术后胃排空延迟的影响。患者被随机分为安慰剂组（n = 32）和奥曲肽组（n = 35）。主要终点是胃排空延迟的发生率，次要终点包括除DGE之外的围手术期发病率。通过临床体征、胃闪烁扫描和氢呼气试验测量DGE。通过单因素和多因素分析来分析除奥曲肽之外的DGE危险因素。
通过临床体征测量的DGE在两个研究组中相似（约20%的患者）。在第7天，奥曲肽组的胃闪烁扫描（T1/2）为76.3±15.2分钟，对照组为86.7±18.0分钟。在第8天，奥曲肽治疗组的H2呼气试验为65.0±6.5分钟，对照组为67.0±5.7分钟。约3%的患者发生了C级POPF，尽管奥曲肽的预防性治疗并未降低POPF的发生率。多因素分析表明，术后腹腔内出血和感染是DGE的独立危险因素。此外，术前胆道支架置入可降低部分十二指肠胰腺切除术后的术后DGE。
预防性使用奥曲肽对胃排空无影响，且不会降低胰十二指肠切除术后胰瘘的发生率。
