Liu Wei, Hua Rong, Sun Yongwei, Zhang Junfeng, Huo Yanmiao, Liu Dejun, Wu Zhiyong, Shi Weijin
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China. Email:
Zhonghua Wai Ke Za Zhi. 2014 Jan;52(1):16-9.
To evaluate the pancreaticojejunostomy procedures selection strategy in pancreaticoduodenectomy and to analyze risk factors of pancreatic fistula.
Clinical data of 352 patients who received pancreaticoduodenectomy from September 2009 to September 2012 were retrospectively analyzed. For patients with soft pancreas, binding pancreaticojejunostomy was applied to 153 patients. For patients with hard pancreas, duct-to-mucosa pancreaticojejunostomy (DMPJ) was applied (199 cases). The clinical efficacy and incidence of postoperative complications were compared among 2 groups. Risk factors of pancreatic fistula were screened out from many factors by univariate and multivariate analysis.
The overall incidence of pancreatic leakage was 13.9% (49/352). There were no significant difference in incidences of pancreatic leakage (χ(2) = 0.512), peritoneal bleeding (χ(2) = 0.784), abdominal infection (χ(2) = 1.161), digestive dysfunction rate (χ(2) = 4.753) and mean duration of hospital stay (t = 2.13) among 2 groups (all P > 0.05). The results of multivariate analysis showed pancreatic tube diameter < 3 mm (OR = 5.748), preoperative total bilirubin level > 171 µmol/L (OR = 5.112), duration of preoperative jaundice > 8 weeks (OR = 5.090), preoperative albumin level < 30 g/L (OR = 4.464) were independent risk factors of pancreatic fistula (all P < 0.05).
Bunding pancreatojejunostomy was as good as soft pancreatic; for duct diameter ≥ 3 mm suggested using duct-to-mucosa pancreaticojejunostomy. For the risk factors for pancreatic leakage actively cooperate with preoperative nutritional support and timely treatment of jaundice, the incidence of postoperative pancreatic leakage will be further reduced.
评估胰十二指肠切除术中胰肠吻合术的术式选择策略，并分析胰瘘的危险因素。
回顾性分析2009年9月至2012年9月行胰十二指肠切除术的352例患者的临床资料。胰腺质地柔软的患者153例行捆绑式胰肠吻合术；胰腺质地坚硬的患者199例行胰管-黏膜吻合术（DMPJ）。比较两组的临床疗效及术后并发症发生率。通过单因素和多因素分析从众多因素中筛选出胰瘘的危险因素。
胰漏总发生率为13.9%（49/352）。两组胰漏发生率（χ(2)=0.512）、腹腔出血发生率（χ(2)=0.784）、腹腔感染发生率（χ(2)=1.161）、消化功能障碍发生率（χ(2)=4.753）及平均住院时间（t=2.13）比较，差异均无统计学意义（均P>0.05）。多因素分析结果显示，胰管直径<3mm（OR=5.748）、术前总胆红素水平>171μmol/L（OR=5.112）、术前黄疸持续时间>8周（OR=5.090）、术前白蛋白水平<30g/L（OR=4.464）是胰瘘的独立危险因素（均P<0.05）。
捆绑式胰肠吻合术与胰腺质地柔软者效果相当；胰管直径≥3mm建议行胰管-黏膜吻合术。针对胰漏的危险因素积极配合术前营养支持及及时治疗黄疸，可进一步降低术后胰漏发生率。
