Department of Surgery, Saint Agnes Hospital and Cancer Center, Baltimore, MD, USA.
Department of Surgery, Saint Agnes Hospital and Cancer Center, Baltimore, MD, USA.
Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):545-551. doi: 10.1016/S1499-3872(17)60053-5.
Postoperative pancreatic fistula (POPF) remains common and morbid after pancreaticoduodenectomy (PD). A major advance in the study of POPF is the fistula risk score (FRS).
We analyzed 48 consecutive patients undergoing PD. The "Colonial Wig" pancreaticojejunostomy (CWPJ) technique was used in the last 22 PDs, we compared 22 CWPJ to 26 conventional PDs.
Postoperative morbidity was 49% (27% Clavien grade >2). The median length of hospital stay was 11 days. In the first 26 PDs, the PJ was performed according to standard techniques and the clinically relevant POPF (CR-POPF) rate was 15%, similar to the FRS-predicted rate (14%). In the next 22 PJs, the CWPJ was employed. Although the FRS-predicted rates were similar in these two groups (14% vs 13%), the CR-POPF rate in the CWPJ group was 0 (P=0.052).
Early experience with the CWPJ is encouraging, and this anastomosis may be a safe and effective way to lower POPF rates.
胰十二指肠切除术（PD）后，术后胰瘘（POPF）仍然很常见且病情严重。POPF 研究的一个主要进展是瘘管风险评分（FRS）。
我们分析了 48 例连续接受 PD 的患者。在最后 22 例 PD 中使用了“殖民假发”胰肠吻合术（CWPJ）技术，我们将 22 例 CWPJ 与 26 例常规 PD 进行了比较。
术后发病率为 49%（27%Clavien 分级>2）。中位住院时间为 11 天。在最初的 26 例 PD 中，根据标准技术进行了 PJ，临床相关的 POPF（CR-POPF）发生率为 15%，与 FRS 预测的发生率（14%）相似。在接下来的 22 例 PJ 中，采用了 CWPJ。尽管这两组的 FRS 预测率相似（14%比 13%），但 CWPJ 组的 CR-POPF 发生率为 0（P=0.052）。
早期使用 CWPJ 的经验令人鼓舞，这种吻合术可能是降低 POPF 发生率的安全有效的方法。
