Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Updates Surg. 2012 Dec;64(4):257-64. doi: 10.1007/s13304-012-0178-8. Epub 2012 Sep 18.
Pancreatic fistula is a major cause of morbidity and mortality after pancreaticoduodenectomy. External drainage of pancreaticojejunostomy anastomosis with a stent is used to reduce the rate of pancreatic fistula. This study compares the rates of pancreatic fistula between external stent drainage versus no-stent drainage for pancreaticojejunal anastomosis following pancreaticoduodenectomy. A total of 53 patients undergoing pancreaticoduodenectomy for various benign and malignant pathologies were included in the study. An external stent was inserted across the anastomosis to drain the pancreatic duct in 26 patients and 27 patients received no stent. The primary end point was pancreatic fistula. All surgeries were done by a single surgeon with expertise in hepatobiliary pancreatic surgery at a single institute. The two groups were comparable in demographic data, underlying pathologies, presenting complaints, presence of comorbid illnesses and proportion of patients with preoperative biliary drainage, pancreatic consistency and duct diameter. The pancreatic fistula rates were similar in both the groups (11.5 vs. 14.8 %, P = 0.725). The morbidity and surgical re-exploration rate were statistically not significant between the two groups (65.4 vs. 51.9 %, P = 0.318 and 11.5 vs. 7.4 %, P = 0.60). Postoperative stay was also similar with a mean of 14 days in both the groups (P = 0.66). The mortality rate was statistically not significant in the two groups (3.8 vs. 7.4 %, P = 0.575). External drainage of pancreaticojejunostomy anastomosis and the pancreatic duct with a stent does not decrease the rate of postoperative pancreatic fistula after pancreaticoduodenectomy.
胰瘘是胰十二指肠切除术后发病率和死亡率的主要原因。通过支架对胰肠吻合口进行外引流可降低胰瘘的发生率。本研究比较了胰十二指肠切除术后胰肠吻合口采用外支架引流与无支架引流对胰瘘发生率的影响。共有 53 例因各种良性和恶性病变接受胰十二指肠切除术的患者纳入本研究。26 例患者在吻合口处插入外支架以引流胰管，27 例患者未放置支架。主要终点是胰瘘。所有手术均由一位在肝胆胰外科方面具有专长的外科医生在一家医院进行。两组在人口统计学数据、基础病变、临床表现、合并症的存在以及术前胆道引流、胰腺质地和胰管直径方面具有可比性。两组的胰瘘发生率相似（11.5%比 14.8%，P=0.725）。两组的发病率和再次手术探查率在统计学上无显著差异（65.4%比 51.9%，P=0.318；11.5%比 7.4%，P=0.60）。两组的术后住院时间也相似，平均为 14 天（P=0.66）。两组的死亡率在统计学上也无显著差异（3.8%比 7.4%，P=0.575）。胰十二指肠切除术后，对胰肠吻合口和胰管进行外引流并放置支架并不能降低术后胰瘘的发生率。
