Departments of Surgery and Oncology, Graduate School of Medical Sciences, 12923Kyushu University, Fukuoka, Japan.
Am Surg. 2022 Jun;88(6):1244-1249. doi: 10.1177/0003134821995088. Epub 2021 Feb 10.
The incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains high. The present study aimed to clarify the efficacy of our modified DuVal (mDuVal) pancreatojejunostomy following DP in patients with a high risk of POPF.
The medical records of 346 consecutive patients who underwent DP between 2006 and 2016 were retrospectively reviewed. Perioperative features were compared between 24 patients undergoing mDuVal (mDuVal group) and 322 patients undergoing standard DP (standard DP group).
Preoperative American Society of Anesthesiologists physical status 1 was more frequent in the standard group than in the mDuVal group ( = .02). The start of a solid diet after operation was significantly earlier in the mDuVal group than in the standard DP group ( = .01), while there were no significant differences between the groups for clinically relevant POPF, amylase concentration in the drainage fluid on postoperative day 1 and days 3-5, time to drain removal, additional intervention for POPF, overall complications, or postoperative hospital stay.
The mDuVal procedure could be an option for patients with a high risk of POPF to improve the outcomes after DP. Further investigation involving large study populations is necessary to clarify the efficacy of this procedure.
胰体尾切除术（DP）后发生术后胰瘘（POPF）的发生率仍然很高。本研究旨在明确改良 DuVal（mDuVal）胰肠吻合术在高 POPF 风险患者中的疗效。
回顾性分析 2006 年至 2016 年间连续 346 例接受 DP 的患者的病历。比较 24 例行 mDuVal（mDuVal 组）和 322 例行标准 DP（标准 DP 组）患者的围手术期特征。
标准组术前美国麻醉医师协会身体状况 1 级的比例高于 mDuVal 组（ =.02）。mDuVal 组术后开始固体饮食的时间明显早于标准 DP 组（ =.01），但两组间临床相关 POPF、术后第 1 天及第 3-5 天引流液中淀粉酶浓度、引流管拔除时间、POPF 额外干预、总并发症或术后住院时间均无显著差异。
mDuVal 术式可能是高 POPF 风险患者 DP 后改善预后的一种选择。需要进一步涉及大样本量的研究来明确该术式的疗效。
