Washio Marie, Yamashita Keishi, Niihara Masahiro, Hosoda Kei, Hiki Naoki
Department of Upper Gastrointestinal Surgery Kitasato University School of Medicine Sagamihara Japan.
Division of Advanced Surgical Oncology Department of Research and Development Center for New Medical Frontiers Kitasato University School of Medicine Sagamihara Japan.
Ann Gastroenterol Surg. 2020 Sep 21;4(6):618-627. doi: 10.1002/ags3.12398. eCollection 2020 Nov.
Postoperative pancreatic fistula is one of the most severe complications after gastric cancer surgery, and can cause critical patient conditions leading to surgery-related death. Fortunately, the incidence of postoperative pancreatic fistula after gastrectomy seems to be decreasing with changes in operative procedures. The rate was reported at about 30% after open gastrectomy with Appleby's method in 1997, but lately has improved below 1% for robotic gastrectomy in 2019. For the diagnosis of postoperative pancreatic fistula, drain amylase concentration has been demonstrated to be beneficial and some reports have proposed the optimal cut-off values of drain amylase to predict major postoperative pancreatic fistula. There have been many reports identifying risk factors for postoperative pancreatic fistula, including overweight patients, pancreatic anatomy, blunt trauma from compression of the pancreas, and thermal injuries caused by the continuous use of energy devices. And importantly, laparoscopic gastrectomy has been shown to be more often associated with postoperative pancreatic fistula than open gastrectomy in the prospective national clinical database in Japan. Hence, further sophistication of surgical techniques to reduce pancreas compression would have great promise in reducing postoperative pancreatic fistula after laparoscopic gastrectomy.
术后胰瘘是胃癌手术后最严重的并发症之一，可导致患者病情危急，甚至引发与手术相关的死亡。幸运的是，随着手术方式的改变，胃切除术后胰瘘的发生率似乎在下降。1997年采用Appleby法行开腹胃切除术时，术后胰瘘发生率约为30%，但最近在2019年机器人辅助胃切除术的发生率已降至1%以下。对于术后胰瘘的诊断，引流液淀粉酶浓度已被证明是有用的，一些报告提出了预测术后主要胰瘘的引流液淀粉酶最佳临界值。已有许多报告确定了术后胰瘘的危险因素，包括超重患者、胰腺解剖结构、胰腺受压钝性损伤以及持续使用能量设备导致的热损伤。重要的是，在日本的前瞻性国家临床数据库中，腹腔镜胃切除术比开腹胃切除术更常与术后胰瘘相关。因此，进一步完善手术技术以减少胰腺受压，对于降低腹腔镜胃切除术后的胰瘘发生率具有很大的前景。
