S Nikhil, Halder P J, R Santhosh, N Ravindra
Department of Surgical Gastroenterology and HPB Surgery, Jagjivan Ram Hospital, Maratha MandirLane, Mumbai Central, Mumbai, 400008 India.
Indian J Surg Oncol. 2019 Mar;10(1):31-36. doi: 10.1007/s13193-018-0747-5. Epub 2018 May 11.
Few studies correlate anatomical parameters of the transected pancreatic neck to occurrence of the dangerous complication-post Whipple's pancreaticoduodenectomy pancreatic fistula. To evaluate the correlation between anatomical details of the transected neck of the pancreas and post-operative pancreatic fistula (POPF) following Whipple's pancreaticoduodenectomy. Observational study. The study included 66 patients undergoing Whipple's pancreaticoduodenectomy with pancreaticojejunostomy at tertiary care centre between December 2009 and December 2014. Student's test, Fisher's exact test, Pearson's chi-squared test and forward stepwise. Clinically relevant POPF (grade B and C) was noted in 12 patients. Morbidity/mortality was 30.30% and 4.54% respectively. Among the fistula v/s no fistula groups, (a) mean thickness of the pancreatic stump was 12.17 ± 1.40 mm v/s 14.94 ± 1.87 mm ( = 0.000), (b) mean width of the pancreatic stump was 24.33 ± 4.14 mm v/s 25.87 ± 4.02 mm ( = 0.238) and (c) mean pancreatic duct (PD) diameter was 2.92 ± 0.79 mm v/s 4.27 ± 1.39 mm ( = 0.001). Mean distances of PD from anterior, posterior, superior and inferior pancreatic borders in the fistula group v/s no fistula group were 6.08 ± 1.62 mm, 3.17 ± 0.72 mm, 9.92 ± 2.15 mm, and 11.42 ± 3.45 mm v/s 5.93 ± 1.71 mm, 4.83 ± 1.26 mm, 11.83 ± 2.79 mm and 9.96 ± 3.25 mm respectively. Eleven of 38 patients (28.9%) with soft pancreas developed POPF. Pancreatic duct < 3 mm diameter, < 3 mm from posterior border, < 12 mm from superior border, pancreatic neck thickness < 12 mm and soft pancreas consistency were significantly associated with POPF.
很少有研究将胰腺颈部横断的解剖学参数与危险并发症——Whipple胰十二指肠切除术后胰瘘的发生相关联。为了评估胰腺横断颈部的解剖细节与Whipple胰十二指肠切除术后胰瘘（POPF）之间的相关性。观察性研究。该研究纳入了2009年12月至2014年12月期间在三级医疗中心接受Whipple胰十二指肠切除术并行胰空肠吻合术的66例患者。采用学生t检验、Fisher精确检验、Pearson卡方检验和向前逐步回归分析。12例患者出现临床相关的POPF（B级和C级）。发病率/死亡率分别为30.30%和4.54%。在胰瘘组与无胰瘘组中，（a）胰腺残端平均厚度为12.17±1.40mm对14.94±1.87mm（P=0.000），（b）胰腺残端平均宽度为24.33±4.14mm对25.87±4.02mm（P=0.238），（c）胰管（PD）平均直径为2.92±0.79mm对4.27±1.39mm（P=0.001）。胰瘘组与无胰瘘组中，PD距胰腺前、后、上、下边界的平均距离分别为6.08±1.62mm、3.17±0.72mm、9.92±2.15mm和11.42±3.45mm，对5.93±1.71mm；4.83±1.26mm、11.83±2.79mm和9.96±3.25mm。38例胰腺质地柔软的患者中有11例（28.9%）发生POPF。胰管直径<3mm、距后边界<3mm、距上边界<12mm、胰腺颈部厚度<12mm以及胰腺质地柔软与POPF显著相关。
