Søreide Kjetil, Labori Knut Jørgen
a Department of Gastrointestinal Surgery , HPB Unit, Stavanger University Hospital , Stavanger , Norway ;
b Department of Clinical Medicine , University of Bergen , Bergen , Norway ;
Scand J Gastroenterol. 2016 Oct;51(10):1147-54. doi: 10.3109/00365521.2016.1169317. Epub 2016 May 23.
Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers.
A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF.
A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained.
Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF.
就死亡率而言，胰腺手术已发展成为一种相当安全的手术，但仍受到较高发病率的困扰。术后胰瘘（POPF）的发生是最常见且令人担忧的并发症之一。POPF的预测和预防仍是一个存在争议的领域，有几个问题尚未得到确凿的答案。
对2005年1月至2015年12月期间英文文献（PubMed/MEDLINE、Cochrane图书馆、EMBASE）中关于POPF危险因素和预防策略的系统评价/荟萃分析及随机试验进行系统综述。
在过去十年中，共有49项系统评价和荟萃分析讨论了POPF的患者、外科医生、胰腺疾病及术中相关因素。不可改变的因素（年龄、体重指数、合并症）和表明手术情况的病理因素（组织类型、腺体质地、导管大小）与POPF风险相关。考虑吻合技术和使用生长抑素类似物可能会轻微改变瘘的风险。密封剂产品似乎没有效果。围手术期出血和输血会增加风险，但可通过注重技术和培训来改变。引流管可能无法预防瘘，但有助于早期发现。早期引流液淀粉酶检测可能有助于发现。预测评分缺乏统一验证，但如果能获得可靠的术前危险因素，可能在患者信息告知方面发挥作用。
POPF的发生是由多种已证实的危险因素导致的。吻合技术和使用生长抑素类似物可能会轻微降低风险。引流管有助于早期发现渗漏，但不能预防POPF。
