Funovics J M, Zöch G, Wenzl E, Schulz F
Surg Gynecol Obstet. 1987 Jun;164(6):545-8.
Fistulas of the pancreas due to dehiscence of pancreaticojejunostomy after partial pancreaticoduodenectomy caused severe postoperative complications. Whereas various methods with and without anastomosis of the pancreas are recommended to deal with the pancreatic stump, mortality rates of 20 to 75 per cent have been reported. These different results prompted us to start a prospective, nonrandomized study in which three methods of reconstructing the remnant of the pancreas involving anastomosis were compared with pancreaticocutaneous drainage without anastomosis. One hundred and thirty-one patients with partial pancreaticoduodenectomy entered this trial, 54 female and 77 male patients with an average age of 55.9 years. The indications included: 42 instances of chronic pancreatitis, 44 instances of carcinoma of the pancreas and 45, periampullary carcinoma. We performed 33 end to side pancreaticojejunostomy procedures (four fistulas of the pancreas, a mortality rate of 15.0 per cent), 31 end to end anastomoses (three fistulas of the pancreas, a mortality rate of 6.5 per cent) and 48 double loops with anastomoses of the pancreatic and hepatic duct to separate jejunal loops (nine fistulas of the pancreas, a mortality rate of 2 per cent). Nineteen patients were operated upon using external drainage of the pancreatic stump by means of Penrose drains (five fistulas of the pancreas, a mortality rate of zero per cent). To reduce the fatal risks caused by combined fistulas of the pancreas and biliary tract, the use of separate intestinal loops for anastomoses of the pancreas and biliary tract offers the best solution, since no fatal complications of the pancreaticojejunostomy were observed. In contrast, pancreaticocutaneous drainage was performed upon patients with endangered pancreatic anastomoses due to local morphologic conditions, such as tender pancreatic parenchyma or thin pancreatic ducts. The total loss of exocrine function and the high morbidity rate of 37 per cent is justified in spite of the mortality rate of zero per cent. Total pancreaticoduodenectomy, for technical reasons, represents no acceptable alternative in view of higher mortality rates.
部分胰十二指肠切除术后胰肠吻合口裂开所致的胰瘘会引发严重的术后并发症。尽管针对胰残端的处理推荐了多种有无胰腺吻合的方法，但据报道死亡率在20%至75%之间。这些不同的结果促使我们开展一项前瞻性、非随机研究，比较三种涉及吻合的胰腺残端重建方法与不进行吻合的胰皮引流术。131例行部分胰十二指肠切除术的患者进入该试验，其中54例女性，77例男性，平均年龄55.9岁。适应证包括：42例慢性胰腺炎、44例胰腺癌和45例壶腹周围癌。我们进行了33例端侧胰肠吻合术（4例胰瘘，死亡率为15.0%）、31例端端吻合术（3例胰瘘，死亡率为6.5%）以及48例胰管和肝管与分离的空肠袢吻合的双袢吻合术（9例胰瘘，死亡率为2%）。19例患者通过彭罗斯引流管对胰残端进行外引流手术（5例胰瘘，死亡率为0%）。为降低胰瘘和胆道联合瘘导致的致命风险，将胰腺和胆道吻合分别使用独立的肠袢是最佳解决方案，因为未观察到胰肠吻合的致命并发症。相比之下，对于因局部形态学状况（如胰腺实质脆弱或胰管纤细）导致胰吻合口危险的患者，则进行胰皮引流。尽管死亡率为0%，但外分泌功能完全丧失以及37%的高发病率是合理的。由于死亡率更高，出于技术原因，全胰十二指肠切除术并非可接受的替代方案。
