Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):528-536. doi: 10.1016/S1499-3872(17)60051-1.
Pancreatic reconstruction following pancreaticoduodenectomy (PD) is still debatable even for pancreatic surgeons. Ideally, pancreatic reconstruction after PD should reduce the risk of postoperative pancreatic fistula (POPF) and its severity if developed with preservation of both exocrine and endocrine pancreatic functions. It must be tailored to control the morbidity linked to the type of reconstruction. This study was to show the best type of pancreatic reconstruction according to the characters of pancreatic stump.
We studied all patients who underwent PD in our center from January 1993 to December 2015. Patients were categorized into three groups depending on the presence of risk factors of postoperative complications: low-risk group (absent risk factor), moderate-risk group (presence of one risk factor) and high-risk group (presence of two or more risk factors).
A total of 892 patients underwent PD for resection of periampullary tumor. BMI >25 kg/m, cirrhotic liver, soft pancreas, pancreatic duct diameter <3 mm, and pancreatic duct location from posterior edge <3 mm are risk variables for development of postoperative complications. POPF developed in 128 (14.3%) patients. Delayed gastric emptying occurred in 164 (18.4%) patients, biliary leakage developed in 65 (7.3%) and pancreatitis presented in 20 (2.2%). POPF in low-, moderate- and high-risk groups were 26 (8.3%), 65 (15.7%) and 37 (22.7%) patients, respectively. Postoperative morbidity and mortality were significantly lower with pancreaticogastrostomy (PG) in high-risk group, while pancreaticojejunostomy (PJ) decreases incidence of postoperative steatorrhea in all groups.
Selection of proper pancreatic reconstruction according to the risk factors of patients may reduce POPF and postoperative complications and mortality. PG is superior to PJ as regards short-term outcomes in high-risk group but PJ provides better pancreatic function in all groups and therefore, PJ is superior in low- and moderate-risk groups.
即使对于胰腺外科医生来说，胰十二指肠切除术（PD）后的胰腺重建仍然存在争议。理想情况下，PD 后的胰腺重建应降低术后胰瘘（POPF）及其严重程度的风险，如果能同时保留外分泌和内分泌胰腺功能，就更好了。它必须根据胰腺残端的特点进行定制，以控制与重建类型相关的发病率。本研究旨在根据胰腺残端的特点，展示最佳的胰腺重建类型。
我们研究了 1993 年 1 月至 2015 年 12 月在我们中心接受 PD 的所有患者。根据术后并发症风险因素的存在情况，将患者分为三组：低危组（无风险因素）、中危组（存在一个风险因素）和高危组（存在两个或更多风险因素）。
共有 892 例患者因壶腹周围肿瘤行 PD 切除术。BMI>25kg/m、肝硬化、胰腺质地软、胰管直径<3mm、胰管位于后缘<3mm 是术后并发症发生的风险变量。128 例（14.3%）患者发生 POPF。164 例（18.4%）患者出现胃排空延迟，65 例（7.3%）患者出现胆漏，20 例（2.2%）患者出现胰腺炎。低危、中危和高危组的 POPF 分别为 26（8.3%）、65（15.7%）和 37（22.7%）例。高危组中，胰腺胃吻合术（PG）可显著降低术后发病率和死亡率，而胰肠吻合术（PJ）可降低所有组的术后脂肪泻发生率。
根据患者的风险因素选择合适的胰腺重建方法可能会降低 POPF 和术后并发症及死亡率。PG 在高危组中短期效果优于 PJ，但 PJ 在所有组中提供更好的胰腺功能，因此在低危和中危组中更具优势。
