Wesley and Princess Alexandra Hospitals, Brisbane, QLD, Australia.
HPB (Oxford). 2013 Aug;15(8):561-6. doi: 10.1111/hpb.12018. Epub 2012 Dec 27.
The aim of this study was to evaluate the effect of topical fibrin glue applied externally to all anastomoses after a pancreaticoduodenectomy (PD) on drain lipase levels, anastomotic leaks, complication rates and length of hospital stay.
A standardized non-pylorus preserving PD was performed with or without fibrin glue applied to each anastomosis.
Fifty-seven patients were randomized: 32 with and 25 without TISSEEL. There were no statistical differences in each group with respect to drain lipase levels (high 40% versus 43%, P = 0.794), complications including gastric or biliary leaks (24% versus 28%, P = 1.00), wound infection (16% versus 9%, P = 0.28) and a Clavien score of 3 or more (16% versus 25%, P = 0.757) or hospital stay (12 versus 17 days, P = 0.777). Most patients with elevated drain lipase levels had an unaltered clinical course not predictive of adverse outcomes. However, the operative finding of a soft pancreas (27 out of 57 patients) was associated with post-operative complications (P = 0.002). There were no peri-operative deaths.
Fibrin glue application to all anastomoses does not alter drain lipase levels. Drain lipase levels are not a significant surrogate marker for clinically significant anastomotic leaks or complications. Fibrin glue application did not reduce the incidence of an anastomotic leak or complications.
本研究旨在评估在胰十二指肠切除术后（PD）将外部纤维蛋白胶应用于所有吻合口对引流脂肪酶水平、吻合口漏、并发症发生率和住院时间的影响。
采用标准化非保留幽门的 PD，对每一处吻合口应用或不应用纤维蛋白胶。
57 例患者随机分组：32 例应用 TISSEEL，25 例未应用。两组在引流脂肪酶水平（高 40%与 43%，P=0.794）、包括胃或胆管漏在内的并发症（24%与 28%，P=1.00）、伤口感染（16%与 9%，P=0.28）和 3 级或以上 Clavien 评分（16%与 25%，P=0.757）或住院时间（12 天与 17 天，P=0.777）方面均无统计学差异。大多数脂肪酶水平升高的患者临床病程未改变，且无不良结局的预测因素。然而，术中发现胰腺质地柔软（57 例患者中有 27 例）与术后并发症相关（P=0.002）。无围手术期死亡。
将纤维蛋白胶应用于所有吻合口不会改变引流脂肪酶水平。引流脂肪酶水平不是临床显著吻合口漏或并发症的重要替代标志物。纤维蛋白胶应用并未降低吻合口漏或并发症的发生率。
