Choi Sae Byeol, Lee Jin Suk, Kim Wan Bae, Song Tae Jin, Suh Sung Ock, Choi Sang Yong
Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Arch Surg. 2012 Feb;147(2):145-50. doi: 10.1001/archsurg.2011.865.
Most morbidity and mortality are caused by a pancreatic fistula after pancreaticoduodenectomy (PD), and its prevention is the major concern. We applied the omental roll-up technique around pancreaticojejunostomy and investigated the effectiveness of this technique to prevent a pancreatic fistula.
Retrospective study.
Tertiary hepatobiliary and pancreas surgery clinic, Korea University Guro Hospital, Seoul.
Between March 1, 2009, and March 31, 2011, 68 patients underwent PD. The patients were divided into 2 groups according to the surgical application of the omental roll-up technique around the PJ site: group 1 (those who did not undergo the omental roll-up technique) compared with group 2 (those who did undergo the omental roll-up technique).
The occurrence of a pancreatic fistula.
No differences were noted in the clinical characteristics, including patients' demographics and operation-related factors, between the 2 groups. A pancreatic fistula occurred in 23 of 39 patients in group 1 (59%) and in 6 of 29 patients in group 2 (20.7%). Group 2 had a significantly lower incidence of pancreatic fistula (P = .002), and these fistulas were classified as being grade A using the International Study Group on Pancreatic Fistula Definition showing a transient high amylase level in the drainage fluid without significantly affecting the patient's recovery. Drain removal was performed earlier in group 2 (P < .001). Mean postoperative hospital stay was 23.4 days in group 1 compared with 15.9 days in group 2 (P = .009). Overall mortality was 1.5%; however, no deaths were related to a pancreatic fistula.
The omental roll-up technique for the PJ site definitely reduced the occurrence of a pancreatic fistula. Therefore, the omental roll-up technique is a simple and effective strategy to prevent a pancreatic fistula.
大多数发病率和死亡率是由胰十二指肠切除术（PD）后胰瘘引起的，其预防是主要关注点。我们在胰空肠吻合术周围应用了网膜卷包技术，并研究了该技术预防胰瘘的有效性。
回顾性研究。
首尔高丽大学九老医院三级肝胆胰外科诊所。
2009年3月1日至2011年3月31日期间，68例患者接受了PD手术。根据胰空肠吻合口周围网膜卷包技术的手术应用情况，将患者分为两组：第1组（未进行网膜卷包技术的患者）与第2组（进行了网膜卷包技术的患者）。
胰瘘的发生情况。
两组在临床特征（包括患者人口统计学和手术相关因素）方面未发现差异。第1组39例患者中有23例（59%）发生胰瘘，第2组29例患者中有6例（20.7%）发生胰瘘。第2组胰瘘发生率显著较低（P = 0.002），根据国际胰瘘研究组的定义，这些胰瘘被分类为A级，表现为引流液中淀粉酶水平短暂升高，而对患者恢复无明显影响。第2组引流管拔除时间更早（P < 0.001）。第1组术后平均住院时间为23.4天，第2组为15.9天（P = 0.009）。总体死亡率为1.5%；然而，没有死亡与胰瘘相关。
胰空肠吻合口的网膜卷包技术确实降低了胰瘘的发生率。因此，网膜卷包技术是预防胰瘘的一种简单有效的策略。
