Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Surgery. 2014 Jul;156(1):75-82. doi: 10.1016/j.surg.2014.03.044.
Common anastomotic complications after pancreatoduodenectomy (PD) are leakage from the pancreaticojejunostomy or hepaticojejunostomy. Leakage from the gastroenteric anastomosis has rarely been described. We evaluated the incidence of gastroenteric leakage after PD and described its presentation, treatment, and outcome.
Between 1992 and 2012, a consecutive series of 1,036 patients underwent PD in the Academic Medical Center. By use of a prospective database and medical records, we identified patients with gastroenteric leakage. Clinicopathologic data were compared with patients without gastroenteric leakage, and presentation, radiologic findings, treatment, and outcome of gastroenteric leaks were analyzed.
Twelve patients (1.2%) had gastroenteric leakage. Patients with gastroenteric leaks had undergone longer operative procedures, had more pancreatic fistulas and other complications, and had a significantly longer hospital stay. Median postoperative day of diagnosis was 8 (range, 2-23). Clinical signs included tender abdomen and high drain output suspicious of gastric content. Common radiologic findings were pneumoperitoneum and intra-abdominal fluid. Seven patients (58%) were treated operatively, 4 (33%) by percutaneous drainage, and 1 (8%) underwent no specific treatment duo to his poor clinical condition. This patient died in hospital, resulting in a hospital mortality of 8%.
Gastroenteric leakage after PD is rare. Clinical presentation is not specific, unlike leakage from other sites. Drain output suspicious of gastric content may help to differentiate from pancreatic or hepatic anastomotic leakage. It may be associated with a longer duration of operation and concomitant pancreatic fistula. A good outcome depends on prompt diagnosis and is mostly achieved by operative intervention.
胰十二指肠切除术（PD）后常见的吻合口并发症是胰肠吻合口或胆肠吻合口漏。胃肠吻合口漏很少见。我们评估了 PD 后胃肠吻合口漏的发生率，并描述了其表现、治疗和结果。
1992 年至 2012 年间，连续 1036 例患者在学术医疗中心接受 PD。通过使用前瞻性数据库和病历，我们确定了有胃肠吻合口漏的患者。比较了有和无胃肠吻合口漏的患者的临床病理数据，并分析了胃肠吻合口漏的表现、影像学发现、治疗和结果。
12 例患者（1.2%）发生胃肠吻合口漏。发生胃肠吻合口漏的患者手术时间较长，胰瘘和其他并发症较多，住院时间明显延长。中位术后诊断时间为 8 天（范围 2-23 天）。临床症状包括腹痛和引流液高量，疑似胃内容物。常见的影像学发现是气腹和腹腔积液。7 例患者（58%）接受手术治疗，4 例（33%）经皮引流治疗，1 例（8%）因临床状况不佳未进行特定治疗。该患者死于医院，院内死亡率为 8%。
PD 后胃肠吻合口漏罕见。临床表现不具特异性，与其他部位的吻合口漏不同。引流液高量疑似胃内容物有助于将其与胰瘘或胆瘘相鉴别。它可能与手术时间延长和并发胰瘘有关。良好的结果取决于及时诊断，主要通过手术干预实现。
