Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Langenbecks Arch Surg. 2010 Aug;395(6):707-12. doi: 10.1007/s00423-009-0547-z. Epub 2009 Aug 5.
Postoperative pancreatic fistula (POPF) is a most striking complication after pancreatic resection. The objective of this study is to reveal the risk factors for POPF defined by the international study group after pancreaticoduodenectomy in a Japanese high-volume center.
During the recent 4 years, 220 patients underwent pancreaticoduodenectomies. In patients of obstructive jaundice, preoperative biliary drainage was performed by percutaneous (n = 71) and/or retrograde (n = 38) approach. Pancreaticojejunostomy was performed using either duct-to-mucosa anastomosis (n = 180) or dunking method (n = 40). Risk factors for POPF (grade B or grade C POPF by international definition) were evaluated using univariate and multivariate analyses.
POPF was found in 109 (50%) patients; grade A in 45 (21%), grade B in 54 (25%), and grade C in 10 patients (5%). One patient died of intra-abdominal hemorrhage caused by POPF. Univariate and multivariate analyses revealed that independent risk factors for grade B or grade C POPF were the size of the main pancreatic duct (<3 mm; relative risk (RR), 3.3; p = 0.002), body mass index (> or =20, RR 2.5, p = 0.03), and bile juice infection on day 1 (RR, 2.2; p = 0.04). The performance of biliary drainage or method of pancreaticojejunostomy was not a significant risk factor for POPF. Bile juice infection on day 1 was significantly associated with retrograde biliary drainage (p < 0.001).
Bile juice infection on day 1 was a significant risk factor for grade B or grade C POPF after pancreaticoduodenectomy. Although the performance or the status of biliary drainage itself was not a risk factor for POPF, percutaneous biliary drainage might be advantageous against retrograde drainage to reduce the risk of biliary infection.
胰十二指肠切除术后胰瘘（POPF）是最显著的并发症之一。本研究旨在揭示日本大容量中心国际研究组定义的胰十二指肠切除术后 POPF 的危险因素。
在最近的 4 年中，220 例患者接受了胰十二指肠切除术。对于梗阻性黄疸患者，经皮（n = 71）和/或逆行（n = 38）途径进行术前胆道引流。胰肠吻合术采用黏膜吻合（n = 180）或套入式吻合（n = 40）。使用单因素和多因素分析评估 POPF（国际定义的 B 级或 C 级 POPF）的危险因素。
109 例（50%）患者发生 POPF；A级 45 例（21%），B 级 54 例（25%），C 级 10 例（5%）。1 例患者因 POPF 引起的腹腔内出血死亡。单因素和多因素分析显示，B 级或 C 级 POPF 的独立危险因素是主胰管大小（<3mm；相对风险（RR）3.3；p = 0.002）、体质量指数（> =20，RR 2.5，p = 0.03）和第 1 天胆汁感染（RR 2.2；p = 0.04）。胆道引流的实施或胰肠吻合术的方法不是 POPF 的显著危险因素。第 1 天胆汁感染与逆行胆道引流显著相关（p < 0.001）。
胰十二指肠切除术后第 1 天胆汁感染是 B 级或 C 级 POPF 的显著危险因素。尽管胆道引流本身的实施或状态不是 POPF 的危险因素，但经皮胆道引流可能优于逆行引流，以降低胆汁感染的风险。
