Noda Hiroshi, Kamiyama Hidenori, Kato Takaharu, Watanabe Fumiaki, Toyama Nobuyuki, Konishi Fumio
Department of Surgery, Saitama Medical Center, Jichi Medical University, Japan.
Hepatogastroenterology. 2012 Sep;59(118):1990-3. doi: 10.5754/hge11821.
BACKGROUND/AIMS: Among several kinds of morbidities, pancreatic fistula (PF) is the most common complication of pancreaticoduodenectomy (PD). However, it has not been clarified what kind of perioperative factors are risk factors of PF after PD is performed by a training surgeon.
We evaluated the risk factors of PF after PD in which all procedures for 100 consecutive patients were performed by a single training surgeon, retrospectively. The 100 cases were divided into two groups and the first 50 cases were named Group A and the latter 50 cases were named Group B.
Multivariate analysis demonstrated that the absence of main pancreatic duct dilatation was an independent risk factor for grade B and grade C PF (p=0.0080; OR=5.311; 95% CI=1.116-7.025). There was no significant difference of the frequencies of grade B and grade C PF between Group A and Group B (p=0.13361).
We demonstrated that the absence of main pancreatic duct dilatation was an independent risk factor for grade B and grade C PF after PD was performed by a training surgeon; for those without pancreatic duct dilatation, PD can be performed by a surgeon in the earlier training period with an acceptable rate of PF.
背景/目的：在多种疾病中，胰瘘（PF）是胰十二指肠切除术（PD）最常见的并发症。然而，对于由实习外科医生实施PD术后，何种围手术期因素是PF的危险因素尚未明确。
我们回顾性评估了由一名实习外科医生连续为100例患者实施所有手术的PD术后PF的危险因素。将这100例病例分为两组，前50例命名为A组，后50例命名为B组。
多因素分析表明，主胰管未扩张是B级和C级PF的独立危险因素（p = 0.0080；OR = 5.311；95%CI = 1.116 - 7.025）。A组和B组之间B级和C级PF的发生率无显著差异（p = 0.13361）。
我们证明，主胰管未扩张是实习外科医生实施PD术后B级和C级PF的独立危险因素；对于那些胰管未扩张的患者，在培训早期阶段的外科医生也可实施PD，且胰瘘发生率可接受。
