Butler James R, Rogers Tyrone, Eckart George, Martens Gregory R, Ceppa Eugene P, House Michael G, Nakeeb Attila, Schmidt C Max, Zyromski Nicholas J
Department of Surgery, Indiana University School of Medicine-IU Health University Hospital, 550 N University Blvd #1295, Indianapolis, IN, 46202, USA.
J Gastrointest Surg. 2015 Apr;19(4):604-12. doi: 10.1007/s11605-015-2765-8. Epub 2015 Feb 18.
Marginal ulcer (MU) is a well-described complication of pancreatoduodenectomy (PD) whose incidence remains unclear. Gastric antisecretory medications likely attenuate the risk of marginal ulceration after PD; however, the true relationship between antisecretory medication and marginal ulceration after PD is not precisely known. The aims of this study were to document the incidence of MU after PD, identify any relationship between MU and gastric antisecretory medication, and survey current practice of MU prophylaxis among experienced pancreatic surgeons.
the MEDLINE, EMBASE, Cochrane Central Registrar of Controlled Trials, and Cochrane Database of Systematic Reviews databases were searched from their inception to May 2014 for abstracts documenting ulceration after pancreatoduodenectomy. Two reviewers independently graded abstracts for inclusion in this review. Contemporary practice was assessed through a four-question survey distributed globally to 200 established pancreatic surgeons.
After a review of 208 abstracts, 54 studies were graded as relevant. These represented a cohort of 212 patients with marginal ulcer after PD (n = 4794). A meta-analysis of the included references shows mean incidence of ulceration after PD of 2.5% (confidence interval (CI) 1.8-3.2%) with a median time to diagnosis of 15.5 months. Pylorus preservation was associated with a MU rate of 2.0% (CI 1.0-2.9%), while "classic" PD procedures report an overall rate of 2.6% (CI 1.6-3.6%). Documented use of postoperative antisecretory medication was associated with a reduced rate of 1.4% (CI 0.1-1.7%). One hundred forty-four of 200 (72%) surveys were returned, from which it was determined that 92% of pancreatic surgeons have dealt with this complication, and 86% routinely prescribe prophylactic antisecretory medication after PD.
The incidence of MU after PD is 2.5% with a median time to occurrence of 15.5 months postoperatively. Gastric antisecretory medication prescription may affect the incidence of MU. The majority of pancreatic surgeons surveyed have encountered MU after PD; most (86%) routinely prescribe prophylactic gastric antisecretory medication.
边缘溃疡（MU）是胰十二指肠切除术（PD）一种广为人知的并发症，但其发病率仍不明确。胃抑酸药物可能会降低PD术后边缘溃疡的风险；然而，抑酸药物与PD术后边缘溃疡之间的真正关系尚不完全清楚。本研究的目的是记录PD术后MU的发病率，确定MU与胃抑酸药物之间的关系，并调查经验丰富的胰腺外科医生目前预防MU的做法。
检索MEDLINE、EMBASE、Cochrane对照试验中央注册库和Cochrane系统评价数据库，从建库至2014年5月，查找记录胰十二指肠切除术后溃疡的摘要。两名审阅者独立对摘要进行评分，以纳入本综述。通过向全球200名知名胰腺外科医生发放的一份包含四个问题的调查问卷评估当代的做法。
在对208篇摘要进行审查后，54项研究被评为相关。这些研究代表了一组212例PD术后边缘溃疡患者（共4794例）。对纳入参考文献的荟萃分析显示，PD术后溃疡的平均发病率为2.5%（置信区间（CI）1.8 - 3.2%），诊断的中位时间为15.5个月。保留幽门与MU发生率为2.0%（CI 1.0 - 2.9%）相关，而“经典”PD手术报告的总体发生率为2.6%（CI 1.6 - 3.6%）。记录显示使用术后抑酸药物与降低至1.4%的发生率相关（CI 0.1 - 1.7%）。200份调查问卷中有144份（72%）被收回，据此确定92%的胰腺外科医生曾处理过这种并发症，86%的医生在PD术后常规开具预防性抑酸药物。
PD术后MU的发病率为2.5%，发病的中位时间为术后15.5个月。胃抑酸药物的处方可能会影响MU的发病率。大多数接受调查的胰腺外科医生在PD术后遇到过MU；大多数（86%）常规开具预防性胃抑酸药物。
