Sachs Teviah E, Tseng Jennifer F
Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, USA.
Ann Surg Oncol. 2021 Apr;28(4):2227-2234. doi: 10.1245/s10434-021-09663-y. Epub 2021 Feb 6.
Pancreaticoduodenectomy is one of the more complicated operations that exists in surgery, and is fraught with potential morbidity, the most well-known, and dreaded, of which is the pancreatic leak. While much of the risk associated with pancreatic leak is inherent to the operation, there have been no shortage of techniques employed by surgeons to try to mitigate that risk.
We focused on four topics of greatest conjecture with regard to reconstruction after pancreaticoduodenectomy: (1) the type of anastomosis, (2) the enteral organ to which the pancreas is sewn, (3) whether to preserve the pylorus and (4) whether or not to use anastomotic silastic stents. We identified the most relevant randomized control trials on each topic, which were appropriately powered.
We identified a total of 15 studies for evaluation, (type of anastomosis: n = 4; enteral organ to which the pancreas is sewn: n = 4; whether to preserve the pylorus, n=3; and whether or not to use anastomotic silastic stents, n = 4). In each group of comparisons, there was no definitive conclusion to be made on superiority of reconstruction.
While clear consensus on how best to reconstruct the anatomy after pancreaticoduodenectomy has not yet been reached, we present the following review in the hope of providing some understanding of the literature for the pancreatic surgeon.
胰十二指肠切除术是外科手术中较为复杂的手术之一，充满了潜在的发病风险，其中最广为人知且令人畏惧的就是胰瘘。虽然与胰瘘相关的许多风险是该手术所固有的，但外科医生不乏采用各种技术来试图降低这种风险。
我们聚焦于胰十二指肠切除术后重建方面最具争议的四个话题：（1）吻合方式；（2）胰腺缝合的肠内器官；（3）是否保留幽门；（4）是否使用吻合口硅橡胶支架。我们确定了每个话题最相关的、样本量合适的随机对照试验。
我们共确定了15项研究进行评估（吻合方式：n = 4；胰腺缝合的肠内器官：n = 4；是否保留幽门，n = 3；是否使用吻合口硅橡胶支架，n = 4）。在每组比较中，对于重建的优越性均未得出明确结论。
虽然对于胰十二指肠切除术后如何最佳地重建解剖结构尚未达成明确共识，但我们进行了以下综述，希望能为胰腺外科医生提供对相关文献的一些理解。
