Dokmak Safi, Ftériche Fadhel Samir, Meniconi Roberto Luca, Aussilhou Béatrice, Duquesne Igor, Perrone Genaro, Romdhani Chihebeddine, Belghiti Jacques, Lévy Philippe, Soubrane Olivier, Sauvanet Alain
Department of HPB surgery and liver transplantation, Beaujon Hospital, APHP, University Paris VII, 100 boulevard du General Leclerc, 92110, Clichy, France.
Department of Anesthesiology and Intensive care medicine, Military Hospital of Tunis, Tunis, Tunisia.
Langenbecks Arch Surg. 2019 Mar;404(2):203-212. doi: 10.1007/s00423-019-01756-3. Epub 2019 Feb 9.
Risk factors of postoperative pancreatic fistula (POPF) after laparoscopic distal pancreatectomy (LDP) are not well known and were studied, including the stapler cartridge size and drainage modality.
Between January 2008 and December 2016, 181 LDP were performed and the pancreas was sectioned by stapler in 130 patients (72%). Patients received white (2.5 mm), blue (3.5 mm), or green (4.1 mm) staplers and the size was not based on any pre or peroperative randomization. As primary analysis of the first 84 patients (28 in each group) showed no effect of stapler size on POPF, we decided to use the white (total = 47) or blue and finally the blue (total = 55) of medium size for standardization. Drainage was obtained by multi-tubular drain (first, 79) and a small suction drain (last, 102). Risk factors of POPF were studied and grades B and C were compared to grade A or no POPF.
POPF (n = 66; 36%) was of grade A (n = 25, 14%), grade B (n = 32, 18%), and grade C (n = 9, 5%). The comparison of the three groups of staplers showed that the blue stapler was used more with a small suction drain (85 vs 23%, p < 0.0001), had lower rate of grade B POPF (p = 0.028), and a shorter hospital stay (p = 0.004). On multivariate analysis, only the use of a small suction drain was associated with significant decrease in grades B and C POPF (6 vs 44%, odds ratio 7.385 (1.919-28.418); p = 0.004).
The occurrence of POPF following LDP is influenced by the type of drainage alone and is significantly decreased with a small suction drain.
腹腔镜远端胰腺切除术（LDP）后胰瘘（POPF）的危险因素尚不明确，故对此展开研究，包括吻合器钉仓尺寸和引流方式。
2008年1月至2016年12月期间，共进行了181例LDP，其中130例（72%）患者的胰腺通过吻合器离断。患者使用白色（2.5毫米）、蓝色（3.5毫米）或绿色（4.1毫米）吻合器，其尺寸并非基于任何术前或术中随机分组。对前84例患者（每组28例）的初步分析显示，吻合器尺寸对POPF无影响，因此我们决定将白色（共47例）或蓝色，最终将中等尺寸的蓝色（共55例）作为标准化使用。引流方式最初采用多管引流（79例），最后采用小口径吸引引流（102例）。研究了POPF的危险因素，并将B级和C级与A级或无POPF进行比较。
POPF（n = 66；36%）分为A级（n = 25，14%）、B级（n = 32，18%）和C级（n = 9，5%）。三组吻合器的比较显示，蓝色吻合器与小口径吸引引流联合使用的比例更高（85%对23%，p < 0.0001），B级POPF发生率更低（p = 0.028），住院时间更短（p = 0.004）。多因素分析显示，仅使用小口径吸引引流与B级和C级POPF显著减少相关（6%对44%，比值比7.385（1.919 - 28.418）；p = 0.004）。
LDP后POPF的发生仅受引流方式影响，小口径吸引引流可显著降低其发生率。
