Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany.
Langenbecks Arch Surg. 2022 Sep;407(6):2517-2525. doi: 10.1007/s00423-022-02531-7. Epub 2022 May 4.
Postoperative pancreatic fistula (POPF) is a complication discussed in the context of pancreatic surgery, but may also result from splenectomy; a relationship that has not been investigated extensively yet.
This retrospective single-center study aimed to analyze incidence of and risk factors for POPF after splenectomy. Patient characteristics included demographic data, surgical procedure, and intra- and postoperative complications. POPF was defined according to the International Study Group on Pancreatic Surgery as POPF of grade B and C or biochemical leak (BL).
Over ten years, 247 patients were identified, of whom 163 underwent primary (spleen-associated pathologies) and 84 secondary (extrasplenic oncological or technical reasons) splenectomy. Thirty-six patients (14.6%) developed POPF of grade B/C or BL, of which 13 occurred after primary (7.9%) and 23 after secondary splenectomy (27.3%). Of these, 25 (69.4%) were BL, 7 (19.4%) POPF of grade B and 4 (11.1%) POPF of grade C. BL were treated conservatively while three patients with POPF of grade B required interventional procedures and 4 with POPF of grade C required surgery. POPF and BL was noted significantly more often after secondary splenectomy and longer procedures. Multivariate analysis confirmed secondary splenectomy and use of energy-based devices as independent risk factors for development of POPF/BL after splenectomy.
With an incidence of 4.5%, POPF is a relevant complication after splenectomy. The main risk factor identified was secondary splenectomy. Although POPF and BL can usually be treated conservatively, it should be emphasized when obtaining patients' informed consent and treated at centers with experience in pancreatic surgery.
术后胰腺瘘（POPF）是胰腺手术中讨论的一种并发症，但也可能由脾切除术引起；然而，这种关系尚未得到广泛研究。
本回顾性单中心研究旨在分析脾切除术后 POPF 的发生率和危险因素。患者特征包括人口统计学数据、手术过程以及围手术期并发症。POPF 根据国际胰腺外科研究组的定义为 B 级和 C 级或生化漏（BL）的 POPF。
在十年期间，共确定了 247 例患者，其中 163 例患者接受了原发性（与脾脏相关的病变）脾切除术，84 例患者接受了继发性（脾脏外肿瘤或技术原因）脾切除术。36 例患者（14.6%）发生了 B/C 级或 BL 的 POPF，其中 13 例发生在原发性脾切除术后（7.9%），23 例发生在继发性脾切除术后（27.3%）。其中，25 例（69.4%）为 BL，7 例（19.4%）为 B 级 POPF，4 例（11.1%）为 C 级 POPF。BL 采用保守治疗，3 例 B 级 POPF 需要介入治疗，4 例 C 级 POPF需要手术治疗。继发性脾切除术和使用能量器械与 BL 或 B/C 级 POPF 的发生显著相关，且手术时间较长。多变量分析证实继发性脾切除术和使用能量器械是脾切除术后发生 POPF/BL 的独立危险因素。
脾切除术后 POPF 的发生率为 4.5%，是一种相关的并发症。确定的主要危险因素是继发性脾切除术。尽管 POPF 和 BL 通常可以保守治疗，但在获得患者知情同意和在具有胰腺手术经验的中心进行治疗时，应强调这一点。
