Department of Surgery, Tuen Mun Hospital, Hong Kong, China.
Department of Surgery, Tuen Mun Hospital, Hong Kong, China.
Am J Surg. 2020 Oct;220(4):976-981. doi: 10.1016/j.amjsurg.2020.02.042. Epub 2020 Mar 2.
Duodenal stump leakage is a challenging condition causing significant morbidity and mortality. The aim of this study is to identify the risk factors associated with duodenal leak and advocate modification to prevent the incident.
A retrospective cohort study was performed to include patients who had gastrectomy with excluded duodenum in a single surgical centre in the period of Jan 2003-March 2017. Analysis of associated factors was performed. Patients with duodenal leak were further analyzed and the treatment strategy was reviewed.
During the study period, 678 patients had gastrectomy with excluded duodenum. 502 patients had elective gastrectomy and 176 patients had emergency gastrectomy. 52 patients had subsequent duodenal stump leakage (7.7%). The existence of duodenal ulcer, intra-operative contamination, lower pre-operative haemoglobin and duodenostomy were the independent associated factors for duodenal leak.
This is the largest cohort in studying associated factors regarding duodenal leak in both emergency and elective gastrectomy. The independent associated factors were identified. We advocate a conservative approach for duodenal leak with adequate drainage, nutrition and antibiotics.
十二指肠残端漏是一种具有挑战性的疾病，会导致显著的发病率和死亡率。本研究旨在确定与十二指肠漏相关的风险因素，并提倡进行修改以预防该事件的发生。
对 2003 年 1 月至 2017 年 3 月期间在单一手术中心接受胃切除术且不包括十二指肠的患者进行回顾性队列研究。对相关因素进行分析。对发生十二指肠漏的患者进行进一步分析，并回顾治疗策略。
在研究期间，有 678 例患者接受了胃切除术且不包括十二指肠。502 例患者为择期胃切除术，176 例患者为急诊胃切除术。52 例患者随后发生十二指肠残端漏（7.7%）。十二指肠溃疡、术中污染、较低的术前血红蛋白和十二指肠造口术是十二指肠漏的独立相关因素。
这是研究急诊和择期胃切除术中十二指肠漏相关因素的最大队列研究。确定了独立的相关因素。我们提倡对十二指肠漏采用保守治疗方法，包括充分引流、营养和抗生素治疗。
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