Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Surg Today. 2011 Jun;41(6):761-6. doi: 10.1007/s00595-011-4515-1. Epub 2011 May 28.
The definitive surgical management of periampullary tumors is a challenging endeavor. This article reviews the available data on the efficacy of various methods of pancreaticoenteric reconstruction designed for the prevention of pancreatic fistula (PF). A literature search of the Medline database was used to identify randomized controlled trials (RCTs) that compared pancreaticojejunostomy (PJ) with pancreaticogastrostomy (PG) after pancreaticoduodenectomy (PD). A total of two metaanalyses and four prospective RCTs were identified. Individual RCTs comparing PJ and PG allow the surgeons participating in the trial to choose technical modifications of one particular technique. As a result, there is no universal agreement as to whether one particular variation is safer and less prone to PF than the others. In addition, the majority of RCTs failed to stratify patient risk of PF. Further studies are therefore necessary to define the optimal technique of pancreatic reconstruction after PD conducted in high-volume centers by high-volume surgeons.
壶腹周围肿瘤的确定性外科治疗是一项具有挑战性的工作。本文综述了各种旨在预防胰瘘（PF）的胰肠吻合术（PJ）与胰胃吻合术（PG）方法的有效性的现有数据。通过对 Medline 数据库进行文献检索，确定了比较胰十二指肠切除术（PD）后 PJ 与 PG 的随机对照试验（RCT）。共确定了两项荟萃分析和四项前瞻性 RCT。比较 PJ 和 PG 的单独 RCT 允许参与试验的外科医生选择一种特定技术的技术修改。因此，对于哪种特定的变化更安全且不易发生 PF，没有普遍的共识。此外，大多数 RCT 未能对 PF 的患者风险进行分层。因此，有必要进一步研究，以确定由高容量外科医生在高容量中心进行 PD 后的最佳胰腺重建技术。
