Department of Digestive Surgery and Surgical Oncology - Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris XIII, 125 rue de Stalingrad, 93000, Bobigny, France.
Department of Digestive Surgery, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014, Paris, France.
J Gastrointest Surg. 2018 Nov;22(11):2021-2028. doi: 10.1007/s11605-018-3859-x. Epub 2018 Jul 6.
With an increasing postoperative survival and prolonged follow-up, late complications following pancreaticoduodenectomy (PD) have yet to be thoroughly described and analyzed. Among those, pancreatic anastomosis stricture may lead to severe consequences.
A systematic review focusing on pancreaticojejunostomy anastomosis (PJA) stricture.
PJA stricture incidence reached 1.4-11.4% with a median time interval of 34 months after PD. No risk factor was identified. PJA stricture repercussions were inconsistent but postprandial abdominal pain and recurrent acute pancreatitis were the most common symptoms, followed by impaired pancreatic function. To confirm diagnosis, secretin-enhanced magnetic resonance cholangiopancreatography (SMRCP) sensitivity reached 56-100%. As impaired pancreatic function is not improved by any procedure, only PJA stricture leading to abdominal pain or acute pancreatitis should be considered for treatment. Endoscopic techniques (mainly ultrasound-assisted "rendezvous") should be proposed prior to surgical repair, with a morbidity, an overall technical and clinical success reaching 16.5-33% and 28.6-100% and 33-100%, respectively. Regarding surgical repair, overall morbidity varied between 14.3 and 33%, with a clinical success reaching 26.1-100%. Finally, total pancreatectomy with islet auto-transplantation should be considered only for pain intractable to medical management and recurrent acute pancreatitis which has failed medical, endoscopic, and traditional surgical management strategies.
PJA stricture following PD is a late, unusual, and potentially serious complication. When there is currently no clear consensus, PJA stricture leading to abdominal pain or acute pancreatitis should be considered treatment. With increasing survival after PD, further studies should focus on late complications.
Stricture of pancraticojejunostomy is a late and potentially serious complication after pancreaticoduodenectomy. Incidence reaches 1.4-11.4% and no risk factor is identified. Symptoms are inconsistent but postprandial abdominal pain, recurrent acute pancreatitis, and impaired pancreatic function are the most frequent. To confirm diagnosis, secretin-enhanced magnetic resonance cholangiopancreatography is the best modality. Only PJA stricture leading to abdominal pain or acute pancreatitis should be considered for treatment. Endoscopic techniques (mainly ultrasound-assisted "rendezvous") should be proposed prior to surgical repair. Finally, total pancreatectomy with islet auto-transplantation should be considered only for pain intractable to medical management and recurrent acute pancreatitis which has failed medical, endoscopic, and traditional surgical management strategies.
随着胰十二指肠切除术（PD）术后生存率的提高和随访时间的延长，胰肠吻合口（PJA）狭窄等术后晚期并发症尚未得到充分描述和分析。其中，胰肠吻合口狭窄可能导致严重后果。
系统回顾重点关注胰肠吻合口狭窄。
PD 术后 PJA 狭窄发生率为 1.4%-11.4%，中位时间间隔为 34 个月。没有发现明确的危险因素。PJA 狭窄的影响不一致，但最常见的症状是餐后腹痛和复发性急性胰腺炎，其次是胰腺功能受损。为了明确诊断，促胰液素增强磁共振胰胆管成像（SMRCP）的敏感性为 56%-100%。由于任何治疗都不能改善胰腺功能受损，只有导致腹痛或急性胰腺炎的 PJA 狭窄才需要考虑治疗。内镜技术（主要是超声辅助的“会师”）应在手术修复之前提出，其发病率、总体技术和临床成功率分别为 16.5%-33%、28.6%-100%和 33%-100%。对于手术修复，总发病率在 14.3%-33%之间，临床成功率为 26.1%-100%。最后，只有在药物治疗无效的难治性腹痛和药物、内镜和传统手术治疗策略失败的复发性急性胰腺炎时，才应考虑行全胰切除术加胰岛自体移植。
PD 后 PJA 狭窄是一种罕见的、潜在严重的晚期并发症。目前尚无明确共识，只有导致腹痛或急性胰腺炎的 PJA 狭窄才应考虑治疗。随着 PD 后生存率的提高，应进一步研究晚期并发症。
胰肠吻合口狭窄是 PD 术后的一种迟发性、潜在严重并发症。发生率为 1.4%-11.4%，无明确危险因素。症状不一致，但餐后腹痛、复发性急性胰腺炎和胰腺功能受损最常见。为了明确诊断，促胰液素增强磁共振胰胆管成像（SMRCP）是最佳方法。只有导致腹痛或急性胰腺炎的 PJA 狭窄才应考虑治疗。内镜技术（主要是超声辅助的“会师”）应在手术修复之前提出。最后，只有在药物治疗无效的难治性腹痛和药物、内镜和传统手术治疗策略失败的复发性急性胰腺炎时，才应考虑行全胰切除术加胰岛自体移植。
