Department of Surgery, George Washington University Medical Center, Washington, DC, USA.
J Gastrointest Surg. 2019 Nov;23(11):2211-2215. doi: 10.1007/s11605-019-04164-6. Epub 2019 Mar 18.
A soft pancreas has been associated with an increased risk of post-operative pancreatic fistula formation. Few studies have evaluated the effect of anastomotic technique (duct to mucosa vs invagination) on fistula formation. This study aims to compare the effect of anastomotic technique on fistula formation among patients with a soft pancreas in a large multiinstitutional database.
The targeted pancreas module of the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) Database was used. All patients with a soft pancreas who underwent pancreaticoduodenectomy from 2014 to 2015 were identified. Demographic data, comorbid conditions, operative variables, and 30-day outcomes were compared using univariate and multivariable analyses.
A total of 975 patients met inclusion criteria. Eight-hundred fifty four (88%) underwent a duct to mucosa pancreaticojejunostomy technique and 121 (12%) underwent invagination. Patients who underwent invagination had higher 30-day mortality (5.8% vs 1.4%, p < 0.01), higher fistula formation (38% vs 25%, p < 0.01), and more often had percutaneous drain placement post-operatively (27% vs 14%, p < 0.01). Following multivariable analysis, invagination remained associated with pancreatic fistula formation (OR 2.5, CI 1.4-4.3) and post-operative percutaneous drain placement (OR 1.8, CI 1.1-2.9).
Invagination technique for pancreaticojejunostomy in patients with a soft pancreas is associated with increased rates of pancreatic fistula. Surgeons should consider utilizing a duct to mucosa technique when feasible to decrease morbidity following pancreaticoduodenectomy in this patient population.
胰腺质地柔软与术后胰瘘形成风险增加有关。很少有研究评估吻合技术（管对黏膜与套入式）对瘘形成的影响。本研究旨在通过美国外科医师学会-国家外科质量改进计划（NSQIP）数据库的胰腺靶向模块，比较吻合技术对胰腺质地柔软患者术后瘘形成的影响。
确定了 2014 年至 2015 年间接受胰十二指肠切除术且胰腺质地柔软的所有患者。使用单变量和多变量分析比较人口统计学数据、合并症、手术变量和 30 天结果。
共有 975 例患者符合纳入标准。854 例（88%）行胰管黏膜吻合术，121 例（12%）行套入式吻合术。行套入式吻合术的患者 30 天死亡率更高（5.8%比 1.4%，p<0.01），瘘形成发生率更高（38%比 25%，p<0.01），术后更常放置经皮引流管（27%比 14%，p<0.01）。多变量分析后，套入式吻合仍与胰瘘形成（OR 2.5，95%CI 1.4-4.3）和术后经皮引流放置（OR 1.8，95%CI 1.1-2.9）相关。
在胰腺质地柔软的患者中行胰肠套入式吻合术与更高的胰瘘发生率相关。对于该患者人群，当可行时，外科医生应考虑使用胰管黏膜吻合技术以降低胰十二指肠切除术后的发病率。
