Yin Jie, Lu Zipeng, Wu Pengfei, Wu Junli, Gao Wentao, Wei Jishu, Guo Feng, Chen Jianmin, Jiang Kuirong, Miao Yi
Department of General Surgery, Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
World J Surg. 2018 Nov;42(11):3726-3735. doi: 10.1007/s00268-018-4679-6.
Postoperative pancreatic fistula (POPF) is a major complication and main cause of mortality after pancreaticoduodenectomy (PD). Afferent loop decompression technique (ALDT) has theoretical feasibility to reduce the rate of POPF. The aim of this study is to determine whether ALDT is a protective factor for POPF.
A total of 492 consecutive patients who underwent PD between January 2012 and December 2014 were identified from a prospective database. All data were extracted and events were judged based on medical records. Propensity score matching was conducted to balance several variables. Univariate and multivariate analyses were performed, respectively, to investigate the independent risk factors for pancreatic fistula. ALDT required a nasogastric tube with multiple side holes to be placed deep into the afferent jejunal limb. The rationale for this technique was to prevent pancreatic fistula by decreasing intraluminal pressure in the afferent jejunal loop by placement of the nasogastric tube and the application of continuous low-pressure suction after surgery.
The total rate of POPF for the entire cohort was 30.7%, and ISGPS grade-A/B/C POPF rates were 18.1, 10.6 and 2.0%, respectively. In-hospital mortality was 1.6%. Among the 331 patients who received ALDT, 89 developed pancreatic leakage (26.9 vs. 38.5% for non-ALDT; P = 0.009) and eight developed biliary leakage (2.4 vs. 6.2% for non-ALDT; P = 0.035). Apart from ALDT, decreased preoperative ALT, soft pancreas, long operative time and tumour presence in the lower common bile duct (as opposed to the pancreas) were identified as other independent risk factors for POPF following multivariate logistic regression analysis.
ALDT may reduce the incidence of POPF after PD.
术后胰瘘（POPF）是胰十二指肠切除术（PD）后的主要并发症及死亡的主要原因。输入袢减压技术（ALDT）在降低POPF发生率方面具有理论可行性。本研究旨在确定ALDT是否为POPF的保护因素。
从一个前瞻性数据库中识别出2012年1月至2014年12月期间连续接受PD的492例患者。提取所有数据并根据病历判断相关事件。进行倾向评分匹配以平衡多个变量。分别进行单因素和多因素分析，以研究胰瘘的独立危险因素。ALDT需要将一根带有多个侧孔的鼻胃管深入放置到输入空肠袢中。该技术的原理是通过放置鼻胃管降低输入空肠袢内的腔内压力，并在术后应用持续低压吸引来预防胰瘘。
整个队列的POPF总发生率为30.7%，国际胰腺外科研究组（ISGPS）分级为A/B/C级的POPF发生率分别为18.1%、10.6%和2.0%。住院死亡率为1.6%。在接受ALDT的331例患者中，89例发生胰漏（非ALDT组为26.9% vs. 38.5%；P = 0.009），8例发生胆漏（非ALDT组为2.4% vs. 6.2%；P = 0.035）。多因素逻辑回归分析显示，除ALDT外，术前谷丙转氨酶（ALT）降低、胰腺质地柔软、手术时间长以及肿瘤位于胆总管下段（而非胰腺）是POPF的其他独立危险因素。
ALDT可能降低PD术后POPF的发生率。
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