Department of Internal Medicine and Surgery (DIMEC), S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Policlinico S.Orsola-Malpighi, Alma Mater Studiorum-Università di Bologna, Via Massarenti n.9, 40138, Bologna, Italy.
J Gastrointest Surg. 2021 Feb;25(2):411-420. doi: 10.1007/s11605-020-04528-3. Epub 2020 Jan 29.
The Blumgart anastomosis is a method of pancreaticojejunostomy after pancreaticoduodenectomy (PD) which combines the principle of duct-to-mucosa anastomosis with an invagination technique of the pancreas.
Retrospective study involving consecutive patients who underwent pancreaticoduodenectomy for pancreatic head cancer. Data predictive of pancreatic fistula and postoperative outcomes were collected. The patients were divided into three groups and were compared based on the type of pancreatic anastomosis performed: Blumgart anastomosis (BA), duct-to-mucosa anastomosis (DtoM), and invagination pancreaticojejunostomy (PJ). The primary endpoint was to determine the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF). The secondary endpoints were to determine whether postoperative pancreatic fistula grade C (POPF C) and/or severe complications occurred as well as to determine the reoperation rate and 30- and 90-day mortality. A propensity score matching analysis was used.
Using propensity score matching (PSM), the occurrence of CR-POPF was not significantly different between the BA (21.6%) and the other pancreatic anastomoses (all 31.1%, DtoM = 27.0%; PJ = 35.1%). However, the BA significantly reduced (1) severe complications (0 versus 35.1%; P < 0.001) and 90-day mortality (0% versus 12.2%; P = 0.028) with respect to all anastomoses; (2) severe complications (0% versus 29.7%; P < 0.001), POPF grade C (0% versus 16.2%; P = 0.025), and reoperation (2.7% versus 16.2%; P = 0.056) with respect to DtoM; and (3) severe complications (0% versus 40.5%; P < 0.001) and 90-day mortality (0% versus 13.5%; P = 0.054) with respect to PJ.
Applying the PSM analysis for the first time, the present study seemed to suggest that the BA succeeded in minimizing severe complications after PD.
Blumgart 吻合术是一种胰十二指肠切除术后（PD）的胰肠吻合术方法，它结合了黏膜吻合术的原理和胰腺的套入技术。
回顾性研究纳入了连续接受胰头癌 PD 治疗的患者。收集了预测胰瘘和术后结局的资料。根据施行的胰肠吻合术类型，将患者分为三组进行比较：Blumgart 吻合术（BA）、胰管黏膜吻合术（DtoM）和套入式胰肠吻合术（PJ）。主要终点是确定是否发生临床相关的术后胰瘘（CR-POPF）。次要终点是确定是否发生术后胰瘘 C 级（POPF C）和/或严重并发症，以及确定再次手术率和 30 天及 90 天死亡率。采用倾向评分匹配分析。
采用倾向评分匹配（PSM）后，BA 组（21.6%）与其他胰肠吻合术组（均为 31.1%，DtoM 为 27.0%，PJ 为 35.1%）的 CR-POPF 发生率无显著差异。然而，BA 显著降低了（1）所有吻合术的严重并发症发生率（0 比 35.1%；P < 0.001）和 90 天死亡率（0 比 12.2%；P = 0.028）；（2）与 DtoM 相比，严重并发症发生率（0 比 29.7%；P < 0.001）、POPF C 级（0 比 16.2%；P = 0.025）和再次手术率（2.7%比 16.2%；P = 0.056）；以及（3）与 PJ 相比，严重并发症发生率（0 比 40.5%；P < 0.001）和 90 天死亡率（0 比 13.5%；P = 0.054）。
本研究首次应用倾向评分匹配分析，似乎表明 BA 成功地将 PD 后严重并发症的发生率降到了最低。
