Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, ul. Banacha 1A, 02-097, Warsaw, Poland.
Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, ul. Banacha 1A, 02-097, Warsaw, Poland.
HPB (Oxford). 2019 Sep;21(9):1166-1174. doi: 10.1016/j.hpb.2019.01.006. Epub 2019 Feb 16.
Surgical management of severe pancreatic fistula after pancreatoduodenectomy remains challenging, and carries high mortality. The aim of this retrospective study was to compare different surgical techniques used at relaparotomy for pancreatic fistula after pancreatoduodenectomy, and to identify factors predictive of failure to rescue.
A total of 43 patients after pancreatoduodenectomy developed a pancreatic fistula requiring relaparotomy. The perioperative data and outcomes were reviewed retrospectively.
Completion pancreatectomy, simple drainage of the pancreatic anastomosis and external wirsungostomy were performed in 17, 16, and 10 cases, respectively. The mortality rate for completion pancreatectomy was 47.1%, compared with 56.3% for simple drainage (p = 0.598) and 50.0% for external wirsungostomy (p = 0.883). Simple drainage was associated with a higher rate of further relaparotomies (56.3%) in comparison with completion pancreatectomy (23.5%, p = 0.055) and external wirsungostomy (0%, p = 0.003). A rescue resection of the pancreatic remnant after failed simple drainage resulted invariably in death. On multivariate analysis, the factors predictive of mortality after relaparotomy for pancreatic fistula were organ failure on the day of reoperation (p = 0.001) and need of further surgical reintervention (p = 0.007).
Timely reintervention and appropriate surgical technique are essential for reducing mortality after reoperation for pancreatic fistula after pancreatoduodenectomy.
胰十二指肠切除术后严重胰瘘的手术处理仍然具有挑战性，且死亡率较高。本回顾性研究的目的是比较胰十二指肠切除术后因胰瘘而行再次剖腹手术时使用的不同手术技术，并确定预测无法挽救的因素。
共有 43 例胰十二指肠切除术后发生胰瘘需再次剖腹手术的患者，回顾性分析其围手术期数据和结果。
完成性胰腺切除术、单纯胰吻合口引流术和外引流术分别在 17、16 和 10 例中进行。完成性胰腺切除术的死亡率为 47.1%，而单纯引流术为 56.3%（p=0.598），外引流术为 50.0%（p=0.883）。与完成性胰腺切除术（23.5%，p=0.055）和外引流术（0%，p=0.003）相比，单纯引流术与更高的再次剖腹手术率相关。单纯引流失败后再次进行胰腺残端切除的患者均死亡。多因素分析显示，再次剖腹手术治疗胰瘘后死亡的预测因素为再次手术当天的器官衰竭（p=0.001）和需要进一步手术干预（p=0.007）。
及时再次干预和选择适当的手术技术对于降低胰十二指肠切除术后胰瘘再次手术后的死亡率至关重要。
