Department of Surgery, Faculty of Medicine Mannheim, University Medical Center Mannheim, University of Heidelberg, 68135, Mannheim, Germany.
World J Surg. 2010 Jul;34(7):1579-86. doi: 10.1007/s00268-010-0521-5.
Pancreatic fistula (PF) is the main cause of postoperative morbidity and mortality after pancreatectomy. Two reasons for PF are a "soft" pancreatic texture and a narrow pancreatic duct (high-risk gland). Pancreaticojejunostomy (PJ) may lead to a higher fistula rate in such glands. In the literature there are no data available on risk-adapted assignment of pancreatogastrostomy (PG) in a high-risk gland. Therefore, an observational pilot study was conducted to address this issue.
Since January 2007 the concept of a "risk-adapted pancreatic anastomosis" (RAP) was introduced (PG for high-risk glands). The PF rate, morbidity, and mortality during this period (January 2007 to December 2008, n = 74) were compared to those between January 2004 and December 2006 (n = 119, only PJ). PF was defined according to the International Study Group on Pancreatic Surgery.
Through RAP the PF rate was reduced from 22 to 11% (P = 0.0503). Grade C PF rate was reduced from 6.7 to 1.4% (P = 0.1569) and grade A PF from 6 to 1.4% (P = 0.2537). The PF-associated mortality was reduced from 3.4 to 1.4%. PG revealed a PF rate of 7% and PJ accounted for 19% of PFs (P = 0.1765). There was no incidence of grade C PF following PG. The incidence of intraluminal hemorrhage (P = 0.0422) and delayed gastric emptying (P = 0.0572) was higher following PG.
The rate of PF could be significantly reduced with the use of RAP. One should be cautious about the indication for PG, since it is associated with a higher rate of intraluminal hemorrhage and delayed gastric emptying. There are no long-term results on PG with respect to its durability and function. A general recommendation for its use cannot currently be made.
胰瘘（PF）是胰腺切除术后发病率和死亡率的主要原因。PF 的两个原因是“软”胰腺质地和狭窄的胰管（高危腺体）。在这种腺体中，胰肠吻合术（PJ）可能会导致更高的瘘管发生率。文献中尚无关于高危腺体中分配胰胃吻合术（PG）的风险适应的资料。因此，进行了一项观察性试点研究来解决这个问题。
自 2007 年 1 月以来，引入了“风险适应胰腺吻合术”（RAP）的概念（高危腺体使用 PG）。比较了在此期间（2007 年 1 月至 2008 年 12 月，n = 74）的 PF 发生率、发病率和死亡率与 2004 年 1 月至 2006 年 12 月之间（n = 119，仅 PJ）的结果。根据国际胰腺外科学研究组的定义，PF 被定义为。
通过 RAP，PF 发生率从 22%降至 11%（P = 0.0503）。C 级 PF 发生率从 6.7%降至 1.4%（P = 0.1569），A级 PF 从 6%降至 1.4%（P = 0.2537）。PF 相关死亡率从 3.4%降至 1.4%。PG 的 PF 发生率为 7%，PJ 占 PF 的 19%（P = 0.1765）。PG 后无 C 级 PF 发生。PG 后发生腔内出血的发生率（P = 0.0422）和胃排空延迟（P = 0.0572）较高。
使用 RAP 可显著降低 PF 发生率。对于 PG 的适应证应谨慎，因为它与腔内出血和胃排空延迟的发生率较高有关。PG 关于其耐久性和功能尚无长期结果。目前不能推荐其常规使用。
