Pericoli Ridolfini M, Alfieri S, Gourgiotis S, Di Miceli D, Quero G, Rotondi F, Caprino P, Sofo L, Doglietto B G
Dipartimento di Chirurgica Oncologica, Università Cattolica del Sacro Cuore, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche ''Giovanni Paolo II'', Campobasso, Italia.
Minerva Chir. 2008 Jun;63(3):199-207.
The aim of this study was to identify risk factors related to pancreatic fistula after left pancreatectomy, considering the difference between the use of mechanical suture and the manual suture to close the pancreatic stump.
Sixty-eight patients, undergoing left pancreatectomy, were included in this study during a 10-year period. Eight possible risk factors related to pancreatic fistula were examined, such as demographic data (age and sex), pathology (pancreatic and extrapancreatic), technical characteristics (stump closure, concomitant splenectomy, additional procedures), texture of pancreatic parenchyma, octreotide therapy.
Fourty-one patients (60%) underwent left pancreatectomy for primary pancreatic disease and 27 (40%) for extrapancreatic malignancy. Postoperative mortality and morbidity rates were 1.5% and 35%, respectively. Fourteen patients (20%) developed pancreatic fistula: 4 of them were classified as Grade A, 9 as Grade B and only one as Grade C. Three factors have been significantly associated to the incidence of pancreatic fistula: none prophylactic octreotide therapy, spleen preserving and soft pancreatic texture. It's still unclear the influence of pancreatic stump closure (stapler vs hand closure) in the onset of pancreatic fistula.
In this study the incidence of pancreatic fistula after left pancreatectomy has been 20%. This rate is lower for patients with fibrotic pancreatic tissue, concomitant splenectomy and postoperative prophylactic octreotide therapy.
本研究旨在确定左半胰切除术后胰瘘的相关危险因素，同时考虑使用机械缝合与手工缝合关闭胰腺残端之间的差异。
在10年期间，68例接受左半胰切除术的患者纳入本研究。研究了8个与胰瘘相关的可能危险因素，如人口统计学数据（年龄和性别）、病理情况（胰腺和胰腺外病变）、技术特征（残端关闭方式、同期脾切除术、附加手术）、胰腺实质质地、奥曲肽治疗。
41例（60%）患者因原发性胰腺疾病接受左半胰切除术，27例（40%）因胰腺外恶性肿瘤接受手术。术后死亡率和发病率分别为1.5%和35%。14例（20%）患者发生胰瘘：其中4例为A级，9例为B级，仅1例为C级。有3个因素与胰瘘发生率显著相关：未进行预防性奥曲肽治疗、保留脾脏和胰腺质地柔软。胰腺残端关闭方式（吻合器缝合与手工缝合）对胰瘘发生的影响仍不清楚。
本研究中左半胰切除术后胰瘘发生率为20%。对于胰腺组织纤维化、同期行脾切除术及术后预防性使用奥曲肽治疗的患者，该发生率较低。
