Service de Chirurgie Digestive et Hépatobiliaire, CHU Clermont-Ferrand, Hôtel Dieu-Bd Léon Malfreyt, 63058 Clermont-Ferrand, France.
J Gastrointest Surg. 2010 Apr;14(4):705-10. doi: 10.1007/s11605-009-1125-y.
Pancreatic fistula (PF) is the single most important complication after pancreaticoduodenectomy. Recently, a 0% rate of PF was reported using a binding pancreaticojejunostomy with intussusception of the pancreatic stump. The aim of this study was to assess the safety of this new binding pancreaticojejunostomy in condition most susceptible to PF, i.e. soft pancreas and non-dilated main pancreatic duct.
Forty-five consecutive patients with soft pancreas and non-dilated main pancreatic duct underwent a binding pancreaticojejunostomy. Post-operative PF was defined according to the International Study Group of Pancreatic Fistula.
Four patients (8.9%) developed a PF. In one case, PF developed on post-operative day 3 due to a technical deficiency. In the three other cases, pancreatic fistula developed after the tenth post-operative day; all the patients had local and/or general co-morbidities before PF occurrence.
Binding pancreaticojejunostomy according to Peng is a safe and secure technique that improves the rate of pancreatic fistula, especially in case of soft texture of the pancreas remnant. However, a 0% rate seems to be hard to achieve because other abdominal and general complications are frequent and can lead to secondary leakage of the pancreatic anastomosis.
胰瘘是胰十二指肠切除术后最常见的并发症。最近，有报道称采用捆绑式胰肠吻合术，使残胰管内陷，可以使胰瘘发生率降为 0%。本研究旨在评估这种新的捆绑式胰肠吻合术在最易发生胰瘘的情况下（即胰腺质地柔软且主胰管不扩张）的安全性。
45 例胰腺质地柔软且主胰管不扩张的患者接受了捆绑式胰肠吻合术。术后胰瘘的定义根据国际胰腺瘘研究组的标准。
4 例患者（8.9%）发生胰瘘。其中 1 例在术后第 3 天由于技术缺陷发生胰瘘。另外 3 例在术后第 10 天发生胰瘘；所有患者在发生胰瘘前均有局部和/或全身合并症。
Peng 提出的捆绑式胰肠吻合术是一种安全可靠的技术，可以降低胰瘘的发生率，特别是在残胰质地柔软的情况下。然而，要达到 0%的胰瘘发生率似乎很难，因为其他腹部和全身并发症很常见，可能导致胰吻合口的二次渗漏。
