Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, South Korea.
J Gastrointest Surg. 2011 Dec;15(12):2187-92. doi: 10.1007/s11605-011-1726-0. Epub 2011 Oct 15.
Postoperative pancreatic fistula remains a troublesome complication after pancreatoduodenectomy (PD), and many authors have suggested factors that affect pancreatic leakage after PD. The International Study Group on Pancreatic Fistula (ISGPF) published a classification, but the new criteria adopted have not been substantially validated. The aims of this study were to validate the ISGPF classification and to analyze the risk factors of pancreatic leakage after duct-to-mucosa pancreatojejunostomy by a single surgeon.
All patient data were entered prospectively into a database. The risk factors for pancreatic fistula were analyzed retrospectively for 247 consecutive patients who underwent conventional pancreatoduodenectomy or pylorus-preserving pancreatoduodenectomy between June 2005 and March 2009 at the Samsung Medical Center by a single surgeon. Duct-to-mucosa pancreatojejunostomy was performed on all patients. The ISGPF criteria were used to define postoperative pancreatic fistula.
Conventional pancreatoduodenectomy was performed in 84 patients and pylorus-preserving pancreatoduodenectomy in 163. Postoperative complications occurred in 144 (58.3%) patients, but there was no postoperative in-hospital mortality. Pancreatic fistula occurred in 105 (42.5%) [grade A, 82 (33.2%); grade B, 9 (3.6%); grade C, 14 (5.7%)]. However, no difference was evident between the no fistula group and the grade A fistula group in terms of clinical findings, including postoperative hospital stays (11 versus 12 days, respectively, p = 0.332). Mean durations of hospital stay in the grade B and C fistula groups were significantly longer than in the no fistula group (21 and 28.5 days, respectively; p < 0.001). Multivariate analysis revealed that a soft pancreas and a long operation time (>300 min) were individually associated with pancreatic fistula formation of grades B and C.
Although the new ISGPF classification appears to be sound in terms of postoperative pancreatic leakage, grade A fistulas lack clinical implications; thus, we are of the opinion that only grade B and C fistulas should be considered in practice. A soft pancreatic texture and an operation time exceeding 300 min were found to be risk factors of grade B and C pancreatic fistulas.
胰十二指肠切除术（PD）后发生胰瘘仍然是一个棘手的并发症，许多作者提出了影响 PD 后胰漏的因素。国际胰腺瘘研究小组（ISGPF）发布了一个分类，但新采用的标准尚未得到实质性验证。本研究的目的是验证 ISGPF 分类，并分析单一外科医生行胰肠黏膜吻合术后胰漏的危险因素。
所有患者数据均前瞻性地录入数据库。回顾性分析 2005 年 6 月至 2009 年 3 月期间由一位外科医生行常规 PD 或保留幽门的 PD 的 247 例连续患者的胰瘘危险因素。所有患者均行胰肠黏膜吻合术。采用 ISGPF 标准定义术后胰瘘。
84 例行常规 PD，163 例行保留幽门的 PD。144 例（58.3%）患者发生术后并发症，但无术后院内死亡。105 例（42.5%）发生胰瘘[Grade A，82 例（33.2%）；Grade B，9 例（3.6%）；Grade C，14 例（5.7%）]。然而，无胰瘘组和胰瘘 A 级组在临床发现方面无差异，包括术后住院时间（分别为 11 天和 12 天，p=0.332）。胰瘘 B 级和 C 级组的平均住院时间明显长于无胰瘘组（分别为 21 天和 28.5 天，p<0.001）。多因素分析显示，胰腺质地软和手术时间长（>300 分钟）分别与 B 级和 C 级胰瘘形成相关。
尽管新的 ISGPF 分类在术后胰漏方面似乎合理，但胰瘘 A 级缺乏临床意义；因此，我们认为在实践中仅应考虑 B 级和 C 级胰瘘。软胰腺质地和手术时间超过 300 分钟是 B 级和 C 级胰瘘的危险因素。
