使用吻合器进行厚胰腺残端闭合会增加远端胰腺切除术后胰瘘的风险。

Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy.

机构信息

Second Department of Surgery, Wakayama Medical University, School of Medicine, Japan.

出版信息

Am J Surg. 2013 Sep;206(3):352-9. doi: 10.1016/j.amjsurg.2012.11.023. Epub 2013 Jun 24.

DOI:10.1016/j.amjsurg.2012.11.023

PMID:23806829

Abstract

BACKGROUND

The appropriate surgical stump closure after distal pancreatectomy (DP) is still controversial. This study investigated the benefits and risks of stapler closure during DP.

METHODS

The risk factors of pancreatic fistulas were investigated in 122 DPs among 3 types of stump closure: hand-sewn suture (n = 32), bipolar scissors (n = 45), and stapler closure (n = 45).

RESULTS

There was no significant difference in the incidence of pancreatic fistula between the 3 types of stump closure (hand-sewn suture [44%] vs bipolar scissors [37.7%] vs stapler closure [35.5%]). By using receiver operating characteristics curves, 12 mm was the best cutoff value of the thickness of the pancreas for pancreatic fistulas after DP using stapler closure. Three factors (ie, male sex, body mass index >25 kg/m(2), and stapler closure) were independent risk factors of pancreatic fistulas after DP with a pancreas thicker than 12 mm.

CONCLUSIONS

A pancreas thicker than 12 mm significantly increased the incidence of pancreatic fistulas after DP using stapler closure.

摘要

背景

远端胰腺切除术（DP）后合适的残端闭合仍然存在争议。本研究旨在探讨 DP 中使用吻合器闭合的益处和风险。

方法

研究分析了 3 种残端闭合方式（手工缝合[32 例]、双极电剪[45 例]和吻合器闭合[45 例]）下胰瘘的危险因素。

结果

3 种残端闭合方式的胰瘘发生率无显著差异（手工缝合[44%]vs 双极电剪[37.7%]vs 吻合器闭合[35.5%]）。使用受试者工作特征曲线，吻合器闭合时胰腺厚度 12mm 是预测 DP 后胰瘘的最佳截断值。对于胰腺厚度大于 12mm 的 DP，男性、体质指数（BMI）＞25kg/m²和吻合器闭合是胰瘘的独立危险因素。