From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery.
Department of Convergence Medicine, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Pancreas. 2020 Feb;49(2):208-215. doi: 10.1097/MPA.0000000000001470.
The objectives are to investigate the incidence and risk factors associated with symptomatic marginal ulcer (sMU) and analyze their relationship with the use of prophylactic proton pump inhibitors (PPIs) after pancreaticoduodenectomy.
Clinical postoperative outcomes of 72 sMU and 1266 non-sMU were compared and analyzed. We performed a subanalysis of 72 patients with sMU diagnosed within (n = 18) and after 4 months (n = 54). The risk factors associated with sMU incidence were analyzed.
Of the 1338 patients, 72 (5.4%) were diagnosed as having sMU. Eighteen patients (25.0%) were diagnosed during the first 4 months, and 48 (66.7%), within 16 months. Cumulative sMU incidence differed according to the duration of prophylactic PPI use (≥4 months: 7.1% vs <4 months: 10.1%, P < 0.001). The duration of prophylactic PPI use was identified as a risk factor in the multivariable analysis (hazard ratio, 2.294; 95% confidence interval, 1.436-3.664; P = 0.001).
Two-thirds or more of the patients were diagnosed as having sMU within 16 months after surgery. The duration of the prophylactic PPI use was an independent risk factor. We recommend the use of prophylactic PPI for more than 16 months after pancreaticoduodenectomy for periampullary tumors.
研究与胰腺十二指肠切除术后症状性边缘性溃疡（sMU）相关的发生率和危险因素，并分析其与预防性质子泵抑制剂（PPIs）使用的关系。
比较并分析了 72 例 sMU 和 1266 例非 sMU 的术后临床结果。我们对 72 例 sMU 患者进行了亚分析，其中 18 例（25.0%）在术后 4 个月内确诊，54 例（66.7%）在术后 4 个月后确诊。分析了与 sMU 发生率相关的危险因素。
在 1338 例患者中，有 72 例（5.4%）被诊断为 sMU。18 例（25.0%）在术后 4 个月内确诊，48 例（66.7%）在术后 16 个月内确诊。根据预防性 PPI 使用持续时间，sMU 的累积发生率不同（≥4 个月：7.1%；<4 个月：10.1%，P<0.001）。多变量分析显示，预防性 PPI 使用持续时间是一个危险因素（危险比，2.294；95%置信区间，1.436-3.664；P=0.001）。
三分之二或更多的患者在手术后 16 个月内被诊断为 sMU。预防性 PPI 使用持续时间是一个独立的危险因素。我们建议对壶腹周围肿瘤患者在胰腺十二指肠切除术后使用预防性 PPI 超过 16 个月。
