Department of Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka 573-1191, Japan.
Department of Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka 573-1191, Japan.
Int J Surg. 2017 Jun;42:158-163. doi: 10.1016/j.ijsu.2017.04.056. Epub 2017 Apr 29.
Post-operative pancreatic fistula (POPF) is one of the most common causes of death following pancreaticoduodenectomy (PD). The aim of this study was to evaluate the clinical effect of a long-internal stent on the development of POPF in patients with a main pancreatic duct diameter of 3 mm or less.
Patients (N = 108) with a main pancreatic duct (≤3 mm) who underwent PD were included in this single-institution historical control study. Between January 2012 and December 2013, 54 patients had undergone PJ with a long-internal stent across the duct-to-mucosa anastomosis (long-stent group), and between February 2009 and December 2011, 54 patients had undergone PJ without a stent (control).
There was no significant difference between groups (long-stent vs control) in the incidence of POPF (70% vs. 56%, p = 0.110) and grade B/C POPF (26% vs. 26%, p = 1.000). Univariate analysis identified body mass index, extent of blood loss and soft pancreatic parenchyma as risk factors related to POPF. Multivariate analysis identified extent of blood loss and soft pancreatic parenchyma as significant risk factors.
Placement of a long-internal stent during PJ did not reduce POPF after PD in patients with a main pancreatic duct of small diameter.
胰十二指肠切除术（PD）后胰瘘（POPF）是最常见的死亡原因之一。本研究旨在评估在主胰管直径≤3mm 的患者中，长内置支架对 POPF 发展的临床效果。
本单中心历史对照研究纳入了 108 例主胰管（≤3mm）行 PD 的患者。2012 年 1 月至 2013 年 12 月，54 例患者接受了跨胰管-黏膜吻合口的 PJ 长内置支架（长支架组），2009 年 2 月至 2011 年 12 月，54 例患者接受了 PJ 无支架（对照组）。
长支架组和对照组 POPF 的发生率（70% vs. 56%，p=0.110）和 B/C 级 POPF 的发生率（26% vs. 26%，p=1.000）无显著差异。单因素分析确定体重指数、出血量和胰腺软实质为与 POPF 相关的危险因素。多因素分析确定出血量和胰腺软实质为显著的危险因素。
在主胰管小直径的 PD 患者中，PJ 时放置长内置支架并不能降低 POPF 的发生。
