From the Nuffield Department of Surgical Sciences.
Somerville College, University of Oxford.
Pancreas. 2021 Jul 1;50(6):847-851. doi: 10.1097/MPA.0000000000001840.
Pancreatic transplantation is usually performed simultaneously with renal transplantation in the setting of end-stage nephropathy and type 1 diabetes. Surgical methods for dealing with exocrine secretions include bladder drainage, direct duodenojejunostomy and Roux-en-Y (ReY) enteric drainage. Roux-en-Y may confer an advantage over duodenojejunostomy because it distances enteric content from the transplant duodenal anastomosis. We examined the effect of enteric drainage method on transplant outcomes.
Data were obtained from the UK transplant registry on 2172 consecutive pancreatic transplants. Early graft loss was the primary endpoint. Secondary endpoints included return to theater, length of inpatient stay, readmission with pancreatitis, graft survival, and patient survival.
There was no protective effect of ReY drainage (early graft loss, 4.6% vs 3.1%, P = 0.30; hazard ratio, 0.98; 95% confidence interval, 0.63-1.52; P = 0.91). There was a significant association between ReY and return to theater, reflecting either the technique or indication for ReY (multivariate odds ratio, 2.05; 95% confidence interval, 1.38-3.06; P < 0.01). The effect of transplant center on graft survival was assessed and adjusted for.
There was no evidence of a protective benefit of ReY drainage over duodenojejunostomy, but there was an increased risk of return to theater.
在终末期肾病和 1 型糖尿病的背景下，胰腺移植通常与肾移植同时进行。处理外分泌分泌物的手术方法包括膀胱引流、直接十二指肠空肠吻合术和 Roux-en-Y（ReY）肠内引流。与十二指肠空肠吻合术相比，Roux-en-Y 可能具有优势，因为它使肠内容物远离移植十二指肠吻合口。我们研究了肠内引流方法对移植结果的影响。
数据来自英国移植登记处的 2172 例连续胰腺移植。早期移植物丢失是主要终点。次要终点包括返回手术室、住院时间、胰腺炎再入院、移植物存活率和患者存活率。
ReY 引流没有保护作用（早期移植物丢失，4.6%对 3.1%，P=0.30；风险比，0.98；95%置信区间，0.63-1.52；P=0.91）。ReY 与返回手术室之间存在显著关联，反映了 ReY 的技术或适应证（多变量优势比，2.05；95%置信区间，1.38-3.06；P<0.01）。评估了移植中心对移植物存活率的影响，并进行了调整。
没有证据表明 ReY 引流比十二指肠空肠吻合术具有保护作用，但返回手术室的风险增加。
