生长抑素类似物帕瑞肽对远端胰腺切除术后胰瘘的影响。
Impact of pasireotide on postoperative pancreatic fistulas following distal resections.
机构信息
Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Translational Cancer Medicine Research Program, Faculty of Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
出版信息
Langenbecks Arch Surg. 2021 May;406(3):735-742. doi: 10.1007/s00423-021-02083-2. Epub 2021 Jan 20.
PURPOSE
Postoperative pancreatic fistula (POPF), a difficult complication after surgery, can cause peripancreatic fluid collection and infections in the operative area. In addition, pancreatic fluid is corrosive and can lead to postoperative bleeding. Clinically significant grade B and C fistulas (CR-POPF) increase postoperative morbidity, resulting in a prolonged hospital stay. Delaying adjuvant therapy due to fistula formation in cancer patients can affect their prognosis. In this study, we aimed to determine if pasireotide affects fistula formation, and the severity of other complications in patients following pancreatic distal resections.
DATA AND METHODS
Between 2000 and 2016, 258 distal pancreatectomies were performed at Helsinki University Hospital and were included in our analysis. Pasireotide was administered to patients undergoing distal resections between July 2014 and December 2016. Patients received 900-μg pasireotide administered twice daily perioperatively. Other patients who received octreotide treatment were analyzed separately. Complications such as fistulas (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), reoperations, and mortality were recorded and analyzed 90 days postoperatively.
RESULTS
Overall, 47 (18%) patients received pasireotide and 31 (12%) octreotide, while 180 patients (70%) who received neither constituted the control group. There were 40 (16%) clinically relevant grade B and C POPFs: seven (15%) in the pasireotide group, three (10%) in the octreotide group, and 30 (17%) in the control group (p = 0.739). Severe complications categorized as Clavien-Dindo grade III or IV were recorded in 64 (25%) patients: 17 (27%) in the pasireotide group, 4 (6%) in the octreotide group, and 43 (67%) in the control group (p = 0.059). We found no 90-day mortality.
CONCLUSIONS
In this study, pasireotide did not reduce clinically relevant POPFs or severe complications following pancreatic distal resection.
目的
术后胰腺瘘（POPF）是手术后的一种严重并发症，可导致胰周积液和手术部位感染。此外，胰液具有腐蚀性，可导致术后出血。临床意义重大的 B 级和 C 级瘘（CR-POPF）会增加术后发病率，导致住院时间延长。由于癌症患者瘘的形成而延迟辅助治疗可能会影响其预后。在这项研究中，我们旨在确定生长抑素类似物帕瑞肽是否会影响胰腺远端切除术后患者瘘的形成和其他并发症的严重程度。
数据和方法
2000 年至 2016 年间，在赫尔辛基大学医院进行了 258 例胰腺远端切除术，我们对这些患者进行了分析。2014 年 7 月至 2016 年 12 月期间，接受胰腺远端切除术的患者给予帕瑞肽治疗。患者接受 900μg 帕瑞肽，每天两次围手术期给药。单独分析了接受奥曲肽治疗的其他患者。记录并分析术后 90 天的并发症，如瘘（POPF）、胃排空延迟（DGE）、胰切除术后出血（PPH）、再次手术和死亡率。
结果
总体而言，47 例（18%）患者接受了帕瑞肽治疗，31 例（12%）患者接受了奥曲肽治疗，而 180 例（70%）未接受生长抑素类似物治疗的患者为对照组。有 40 例（16%）临床意义重大的 B 级和 C 级 POPF：帕瑞肽组 7 例（15%），奥曲肽组 3 例（10%），对照组 30 例（17%）（p=0.739）。记录到 64 例（25%）严重并发症，分类为 Clavien-Dindo 分级 III 或 IV 级：帕瑞肽组 17 例（27%），奥曲肽组 4 例（6%），对照组 43 例（67%）（p=0.059）。我们未发现 90 天死亡率。
结论
在这项研究中，帕瑞肽并未降低胰腺远端切除术后临床意义重大的 POPF 或严重并发症的发生率。
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