Borel Frédéric, Ouaissi Mehdi, Merdrignac Aude, Venara Aurelien, De Franco Valéria, Sulpice Laurent, Hamy Antoine, Regenet Nicolas
Clinique de Chirurgie Digestive et Endocrinienne, CHU de Nantes, Nantes, France.
Chirurgie Digestive et Générale, CHU de la Timone (AP-HM), Marseille, France.
ANZ J Surg. 2018 Jan;88(1-2):77-81. doi: 10.1111/ans.14049. Epub 2017 Aug 15.
Central pancreatectomy (CP) is an alternative to pancreaticoduodenectomy and distal pancreatectomy in benign tumours of pancreatic isthmus management. It is known for a high post-operative pancreatic fistula (POPF) rate. The purpose of this study was to compare POPF incidence between pancreatico-jejunostomy (PJ) and pancreatico-gastrostomy (PG).
Fifty-eight patients (mean age 53.9 ± 1.9 years) who underwent a CP in four French University Hospitals from 1988 to 2011 were analysed. The distal pancreatic remnant was either anastomosed to the stomach (44.8%, n = 25) or to a Roux-en-Y jejunal loop (55.2%, n = 35) with routine external drainage allowing a systematic search for POPF. POPF severity was classified according to the International Study Group on Pancreatic Fistula (ISGPF) and Clavien-Dindo classifications.
The groups were similar on sex ratio, mean age, ASA score, pancreas texture, operative time and operative blood loss. Mean follow-up was 36.2 ± 3.9 months. POPF were significantly more frequent after PG (76.9 versus 37.5%, P = 0.003). PG was associated with significantly higher grade of POPF both when graded with ISGPF classification (P = 0.012) and Clavien-Dindo classification (P = 0.044). There was no significant difference in post-operative bleeding (0.918) and delayed gastric emptying (0.877) between the two groups. Hospital length of stay was increased after PG (23.6 ± 3.5 days versus 16.5 ± 1.9 days, P = 0.071). There was no significant difference in incidence of long-term exocrine (3.8 versus 19.2%, P = 0.134) and endocrine (7.7 versus 9.4%, P = 0.575) pancreatic insufficiencies.
PG was associated with a significantly higher POPF incidence and severity in CP. We recommend performing PJ especially in older patients to improve CP outcomes.
在胰腺峡部良性肿瘤的治疗中，全胰切除术（CP）是胰十二指肠切除术和胰体尾切除术的替代方案。其以术后胰瘘（POPF）发生率高而闻名。本研究的目的是比较胰空肠吻合术（PJ）和胰胃吻合术（PG）之间的POPF发生率。
分析了1988年至2011年在四家法国大学医院接受CP的58例患者（平均年龄53.9±1.9岁）。胰腺远端残端要么与胃吻合（44.8%，n = 25），要么与Roux-en-Y空肠袢吻合（55.2%，n = 35），并常规进行外引流以便系统地查找POPF。根据国际胰瘘研究组（ISGPF）和Clavien-Dindo分类法对POPF的严重程度进行分类。
两组在性别比例、平均年龄、美国麻醉医师协会（ASA）评分、胰腺质地、手术时间和术中失血方面相似。平均随访时间为36.2±3.9个月。PG术后POPF的发生频率显著更高（76.9%对37.5%，P = 0.003）。无论是按照ISGPF分类法（P = 0.012）还是Clavien-Dindo分类法（P = 0.044）分级，PG相关的POPF分级都显著更高。两组之间术后出血（0.918）和胃排空延迟（0.877）无显著差异。PG术后住院时间延长（23.6±3.5天对16.5±1.9天，P = 0.071）。长期外分泌性胰腺功能不全（3.8%对19.2%，P = 0.134）和内分泌性胰腺功能不全（7.7%对9.4%，P = 0.575）的发生率无显著差异。
在CP中，PG与显著更高的POPF发生率和严重程度相关。我们建议尤其是在老年患者中进行PJ以改善CP的治疗效果。
