Bartoli Eric, Rebibo Lionel, Robert Brice, Fumery Mathurin, Delcenserie Richard, Regimbeau Jean-Marc
Department of Gastroenterology, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France.
Surg Endosc. 2014 May;28(5):1528-34. doi: 10.1007/s00464-013-3347-z. Epub 2013 Dec 14.
Despite improvements in surgical techniques and postoperative care, morbidity associated with pancreatoduodenectomy (PD) is still high. Grade B pancreatic fistula (PF) requires a specific combination of radiologically guided external drainage and medical support. This treatment is effective but requires prolonged hospitalization and maintenance of external drainage. The objective of this study was to evaluate the feasibility and efficacy of a double-pigtail stent (DPS) to treat grade B PF after PD with pancreatogastric anastomosis.
Between January 2008 and October 2011, all patients who presented grade B PF after PD (n = 6) were included in the study. The PF was diagnosed according to the criteria of the International Study Group on Pancreatic Fistula. Endoscopic treatment was standardized with a DPS. The primary efficacy end point was the feasibility and efficacy of DPS placement. Secondary end points included data on the PF, the DPS placement procedure, and long-term outcome.
Endoscopic DPS placement was achieved in all patients with no complications. The median time to onset of PF after PD was 14 days. Closure of the external PF was obtained 7 days after the introduction of the DPS. The median time to external drain removal was 7 days after DPS placement, and the median time to oral refeeding was 7 days after DPS placement for all patients. The median time to DPS removal was 60 days. The median length of hospital stay after DPS placement was 10 days. During a median follow-up period of 21 months, there was no recurrence of PF after removal of the DPS.
Endoscopic treatment of grade B PF after PD appears to be effective and safe and is associated with shorter hospitalization.
尽管手术技术和术后护理有所改进，但胰十二指肠切除术（PD）相关的发病率仍然很高。B级胰瘘（PF）需要放射学引导下的外引流和药物支持的特定组合。这种治疗方法有效，但需要延长住院时间并维持外引流。本研究的目的是评估双猪尾支架（DPS）治疗胰胃吻合术后B级PF的可行性和疗效。
2008年1月至2011年10月，所有PD术后出现B级PF的患者（n = 6）均纳入本研究。根据国际胰瘘研究组的标准诊断PF。采用DPS进行标准化内镜治疗。主要疗效终点是DPS放置的可行性和疗效。次要终点包括PF数据、DPS放置过程和长期结果。
所有患者均成功进行了内镜DPS放置，无并发症发生。PD术后PF出现的中位时间为14天。引入DPS后7天，外部PF闭合。所有患者DPS放置后外引流管拔除的中位时间为7天，经口重新进食的中位时间为7天。DPS拔除的中位时间为60天。DPS放置后住院时间的中位长度为10天。在中位随访期21个月内，拔除DPS后PF无复发。
PD术后B级PF的内镜治疗似乎有效且安全，且住院时间较短。
