Wellner U, Makowiec F, Fischer E, Hopt U T, Keck T
Department of Surgery, Chirurgische Universitätsklinik Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
J Gastrointest Surg. 2009 Apr;13(4):745-51. doi: 10.1007/s11605-008-0763-9. Epub 2008 Dec 13.
Metaanalysis of retrospective studies employing various definitions of pancreatic fistulas demonstrated a reduced postoperative pancreatic fistula rate after pancreatogastrostomy versus pancreaticojejunostomy. Prospective trials failed to do so, which causes an ongoing debate on the superiority of one or the other procedure. The aim of this study was to compare the two types of anastomosis at our institution with regard to postoperative pancreatic fistula and other complications.
From 2001 to 2007, 114 pancreatogastrostomies and 115 pancreaticojejunostomies were performed. For retrospective analysis, the ISGPS definitions were employed. Primary endpoint was the occurrence of postoperative pancreatic fistula grade B or C. Secondary endpoints were postpancreatectomy hemorrhage, delayed gastric emptying, intraabdominal fluid collection, reoperation, and mortality. Operative time, intensive care unit stay, and overall hospital stay were also compared.
With pancreatogastrostomy, there were significantly less postoperative pancreatic fistulae grade B and C (pancreatogastrostomy (PG) versus pancreaticojejunostomy (PJ), 11.4% versus 22.6%, p = 0.03), more intraluminal hemorrhage (PG versus PJ, 10.5% versus 0%, p < 0.001) and more delayed gastric emptying grade B and C (PG versus PJ, 18.3% versus 7.9%, p = 0.03). Operative time was shorter (PG versus PJ, median 420 versus 450 min, p < 0.01), and intensive care unit stay was longer (PG versus PJ, median 4 days versus 5 days, p < 0.01), with a tendency toward reduced overall hospital stay (PG versus PJ, median 17 versus 19 days, p = 0.08).
Surgeons should be aware of a higher rate of delayed gastric emptying and perform meticulous hemostasis to prevent intraluminal bleeding with pancreatogastrostomy. Pancreatogastrostomy is superior to pancreaticojejunostomy in terms of relevant postoperative pancreatic fistula.
对采用各种胰瘘定义的回顾性研究进行的荟萃分析表明，与胰管空肠吻合术相比，胰管胃吻合术后胰瘘发生率降低。前瞻性试验未能证实这一点，这引发了关于这两种手术方式孰优孰劣的持续争论。本研究的目的是比较我院这两种吻合方式在术后胰瘘及其他并发症方面的情况。
2001年至2007年，共进行了114例胰管胃吻合术和115例胰管空肠吻合术。采用国际胰腺外科研究组（ISGPS）的定义进行回顾性分析。主要终点是术后B级或C级胰瘘的发生情况。次要终点包括胰十二指肠切除术后出血、胃排空延迟、腹腔内积液、再次手术及死亡率。同时比较手术时间、重症监护病房住院时间和总住院时间。
胰管胃吻合术组术后B级和C级胰瘘明显较少（胰管胃吻合术（PG）与胰管空肠吻合术（PJ）相比，分别为11.4%和22.6%，p = 0.03），腔内出血更多（PG与PJ相比，分别为10.5%和0%，p < 0.001），B级和C级胃排空延迟更多（PG与PJ相比，分别为18.3%和7.9%，p = 0.
