Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy.
Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy; Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
HPB (Oxford). 2022 Sep;24(9):1474-1481. doi: 10.1016/j.hpb.2022.03.001. Epub 2022 Mar 16.
Biliary leak (BL) after pancreatoduodenectomy (PD) may have diffrent severity depending on its association with postoperative pancreatic fistula (POPF).
Data of 2715 patients undergoing PD between 2011 and 2020 at two European third-level referral Centers for pancreatic surgery were retrospectively reviewed. These included BL incidences, grading, outcomes, specific treatments, and association with POPF.
BL occurred in 6% of patients undergoing PD. Among 143 BL patients, 47% had an associated POPF and 53% a pure BL. Major morbidity (64% vs 36%) and mortality (19% vs 4%) were higher in POPF-associated BL group (all P< 0.01). Day of BL onset was similar between groups (POD 2 vs 3; P = 0.2), while BL closure occurred earlier in pure BL (POD 12 vs 23; P < 0.01). Conservative treatment was more frequent (55% vs 15%; P < 0.01), and the rate of percutaneous and/or trans-hepatic drain placement was lower (30% vs 16%; P = 0.04) in pure BL group. Relaparotomy was more common in POPF-associated BL group (42% VS 17%; P < 0.01) but was performed earlier in pure BL (POD 2 vs 10; P = 0.02).
Pure BL represents a more benign entity, managed conservatively in half of the cases.
胰十二指肠切除术（PD）后胆漏（BL）的严重程度可能因与术后胰瘘（POPF）的关系而有所不同。
回顾性分析了 2011 年至 2020 年在两家欧洲三级胰腺外科转诊中心接受 PD 的 2715 例患者的数据。这些数据包括 BL 的发生率、分级、结果、特定治疗方法以及与 POPF 的关系。
BL 发生在 6%接受 PD 的患者中。在 143 例 BL 患者中，47%的患者存在合并的 POPF，53%的患者为单纯 BL。合并 POPF 的 BL 患者的主要发病率（64%比 36%）和死亡率（19%比 4%）更高（均 P<0.01）。两组患者 BL 发病的天数相似（POD2 比 POD3；P=0.2），但单纯 BL 的 BL 闭合时间更早（POD12 比 POD23；P<0.01）。单纯 BL 患者更常采用保守治疗（55%比 15%；P<0.01），经皮和/或经肝置管引流的发生率更低（30%比 16%；P=0.04）。合并 POPF 的 BL 患者更常需要再次剖腹手术（42%比 17%；P<0.01），但单纯 BL 患者的剖腹手术时间更早（POD2 比 POD10；P=0.02）。
单纯 BL 代表一种更良性的实体，半数患者可采用保守治疗。
