胰十二指肠切除术后ω样胰管-黏膜胰肠吻合术与传统胰管-黏膜胰肠吻合术早期术后结果的比较。

Comparison of early postoperative outcomes between omega-like duct-to-mucosa pancreatojejunostomy and conventional duct-to-mucosa pancreatojejunostomy after pancreaticoduodenectomy.

作者信息

Zheng Minghui, Liu Anan, Li Judong, Liang Xing, Peng Junfeng, Chen Danlei, Shi Ligang, Fu Zhiping, Ji Meng, Yang Guang, Yang Tianbo, Tang Liang, Shao Chenghao

机构信息

Department of Pancreatic-biliary Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China.

出版信息

HPB (Oxford). 2022 May;24(5):606-615. doi: 10.1016/j.hpb.2021.09.017. Epub 2021 Sep 24.

DOI:10.1016/j.hpb.2021.09.017

PMID:34872867

Abstract

BACKGROUND

Pancreatic fistula is a life-threatening complication of pancreaticoduodenectomy. Omega-like duct-to-mucosa pancreatojejunostomy is a novel technique which helps reduce the risk of fistulation. This study aimed to compare early postoperative outcomes of omega-like and conventional pancreatojejunostomy.

METHODS

A retrospective single-centre cohort study comparing outcomes of adult patients who underwent open pancreatoduodenectomy with conventional (CDMP) or omega-like duct-to-mucosa pancreatojejunostomy (ODMP) between 1 January 2015 and 31 December 2019. The primary outcome measure was the pancreatic fistula rate.

RESULTS

440 patients were included in this study of whom 233 underwent CDMP and 207 ODMP. The rate of clinically relevant pancreatic fistula (grade B/C) was significantly higher after CDMP than ODMP (18.5% vs. 10.6%, P = 0.021). 153 patients in CDMP group and 99 patients in ODMP group developed one or more complications (65.7% vs. 47.8%, P = 0.004). The average hospitalization expenses were numerically decreased in ODMP group, although this was not statistically significant (120,000 ± 42,000 [Chinese Yuan] vs. 100,000 ± 40,000 [Chinese Yuan] or 18,581 ± 6503 [United States Dollar] vs. 15,484 ± 6194 [United States Dollar], P = 0.402).

CONCLUSION

ODMP may reduce the incidence of pancreatic fistula and other early postoperative complications after pancreatoduodenectomy.

摘要

背景

胰瘘是胰十二指肠切除术的一种危及生命的并发症。类欧米伽型胰管-黏膜胰空肠吻合术是一种有助于降低胰瘘风险的新技术。本研究旨在比较类欧米伽型和传统胰空肠吻合术的术后早期结局。

方法

一项回顾性单中心队列研究，比较2015年1月1日至2019年12月31日期间接受开放性胰十二指肠切除术的成年患者采用传统（CDMP）或类欧米伽型胰管-黏膜胰空肠吻合术（ODMP）后的结局。主要结局指标是胰瘘发生率。

结果

本研究纳入440例患者，其中233例行CDMP，207例行ODMP。CDMP术后临床相关胰瘘（B/C级）发生率显著高于ODMP（18.5%对10.6%，P = 0.021）。CDMP组153例患者和ODMP组99例患者发生一种或多种并发症（65.7%对47.8%，P = 0.004）。ODMP组平均住院费用在数值上有所降低，尽管无统计学意义（120,000 ± 42,000[人民币]对100,000 ± 40,000[人民币]，或18,581 ± 6503[美元]对15,484 ± 6194[美元]，P = 0.402）。