Department of Surgery, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Nagasaki, Japan.
Pancreas. 2011 Jan;40(1):25-9. doi: 10.1097/MPA.0b013e3181e861fa.
We prospectively investigated the efficacy of an external pancreatic duct stent to prevent pancreatic fistula in the nonfibrotic pancreas after pancreaticojejunostomy, in which the degree of pancreatic fibrosis was assessed objectively by using dynamic magnetic resonance imaging (MRI).
Among the 67 consecutive patients who underwent pancreatic head resection, 45 patients were judged to have a normal pancreas without fibrosis based on the preoperative assessment of pancreatic fibrosis based on MRI. The patients were randomly allocated to 1 of 2 groups with (n=23) or without (n=22) use of an external pancreatic duct stent in performing a pancreaticojejunostomy.
Pancreatic fistula developed in 8 (34.5%) patients in the stented group: 3 grade A and 5 grade B; whereas in the nonstented group, 9 (40.9%) patients developed pancreatic fistula: 3 grade A and 6 grade B. There were no significant differences in the incidence or severity of pancreatic fistula between the 2 groups.
The utility of the external pancreatic duct stent after pancreaticojejunostomy was not found in the nonfibrotic pancreases, which were sorted according to the degree of pancreatic fibrosis using the pancreatic time-signal intensity curve analysis from MRI.
我们前瞻性地研究了在胰肠吻合术后非纤维胰腺中使用外胰管支架预防胰瘘的效果，其中通过动态磁共振成像（MRI）客观评估胰腺纤维化程度。
在连续接受胰头切除术的 67 例患者中，根据 MRI 评估的术前胰腺纤维化程度，45 例患者被判断为无纤维正常胰腺。患者被随机分配到接受（n=23）或不接受（n=22）外胰管支架的胰肠吻合术的 2 组之一。
支架组有 8 例（34.5%）患者发生胰瘘：3 例为 A 级，5 例为 B 级；而未支架组有 9 例（40.9%）患者发生胰瘘：3 例为 A 级，6 例为 B 级。两组之间胰瘘的发生率或严重程度无显著差异。
在根据 MRI 上的胰腺时间-信号强度曲线分析将胰腺纤维化程度进行分类的无纤维胰腺中，胰肠吻合术后使用外胰管支架并没有带来益处。
