Jester Andrea L, Chung Catherine W, Becerra David C, Molly Kilbane E, House Michael G, Zyromski Nicholas J, Max Schmidt C, Nakeeb Attila, Ceppa Eugene P
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 541, Indianapolis, IN, 46202, USA.
J Gastrointest Surg. 2017 Jun;21(6):1017-1024. doi: 10.1007/s11605-017-3406-1. Epub 2017 Mar 24.
Hepaticojejunostomy leaks are less frequent than pancreatic leaks after pancreatoduodenectomy, and the current literature suggests comparable outcomes. The purpose of this study was to determine if the hepaticojejunostomy leak adversely affected patient outcomes.
Consecutive cases of pancreatoduodenectomy (n = 924) were reviewed at a single high-volume institution over an 8-year period (2006-2014).
Pancreaticojejunostomy leaks were identified in 217 (23%) patients and hepaticojejunostomy leaks were identified in 24 patients (3%); combined hepaticojejunostomy/pancreaticojejunostomy leaks were identified in 31 patients (3%). Those with hepaticojejunostomy leaks or combined leaks had a significantly increased risk of morbidity when compared to pancreaticojejunostomy leaks or no leak (54 and 58 vs. 34 and 24%, respectively, p < 0.05). The median length of stay was significantly greater for hepaticojejunostomy leaks or combined leaks when compared to pancreatojejunostomy leaks (17 or 14 vs. 9 days, p = 0.001) and those with no leak (17 or 14 vs. 7 days, p = 0.001). Ninety-day mortality for all patients was 3.6%. Hepaticojejunostomy leaks and combined leaks significantly increased 90-day mortality rate (17 and 32%, respectively, p < 0.05).
Hepaticojejunostomy and combined leaks after pancreatoduodenectomy are rarer than pancreaticojejunostomy leaks; these patients are at a significantly increased risk of major morbidity and mortality.
肝空肠吻合口漏比胰十二指肠切除术后的胰漏发生率更低，目前的文献表明二者预后相当。本研究的目的是确定肝空肠吻合口漏是否会对患者预后产生不利影响。
在一家大型机构对8年期间（2006 - 2014年）连续进行的胰十二指肠切除术病例（n = 924）进行回顾。
217例（23%）患者发现胰空肠吻合口漏，24例（3%）患者发现肝空肠吻合口漏；31例（3%）患者发现肝空肠吻合口/胰空肠吻合口联合漏。与胰空肠吻合口漏或无漏相比，发生肝空肠吻合口漏或联合漏的患者发生并发症的风险显著增加（分别为54%和58%，对比34%和24%，p < 0.05）。与胰空肠吻合口漏相比，肝空肠吻合口漏或联合漏患者的中位住院时间显著更长（分别为17天或14天对比9天，p = 0.001），与无漏患者相比也更长（分别为17天或14天对比7天，p = 0.001）。所有患者的90天死亡率为3.6%。肝空肠吻合口漏和联合漏显著增加了90天死亡率（分别为17%和32%，p < 0.05）。
胰十二指肠切除术后肝空肠吻合口漏和联合漏比胰空肠吻合口漏更少见；这些患者发生严重并发症和死亡的风险显著增加。
