Ouyang Liu, Hu Hao, Nie Gang, Yang Li-Xue, Huang Zhi-Ping, Ni Chen-Ming, Shao Zhuo, Zheng Kai-Lian, Jing Wei, Song Bin, Li Gang, Hu Xian-Gui, Jin Gang
Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
Department of Biliary Tract Surgery II, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Front Oncol. 2022 Aug 17;12:934978. doi: 10.3389/fonc.2022.934978. eCollection 2022.
This study aimed to examine the incidence of bifid pancreatic duct (BPD) in pancreaticoduodenectomy (PD) and clarify its impact on clinically relevant postoperative pancreatic fistula (CR-POPF).
Until now, all the literature about BPD during PD are published as case reports, and the incidence of BPD in PD and its impact on CR-POPF remain unknown.
A total of 438 consecutive PDs were divided into two groups: the former year group and the latter year group. The former year group included 215 consecutive PDs, while the latter year group included 223. In the latter year group, we found 16 BPDs during PD (O-BPD); the incidence of O-BPD is 7.17%. Of them, there were eight patients who had BPD in the preoperative imaging (I-BPD). All the I-BPDs are O-BPDs; which means that 50% of O-BPDs were a single pancreatic duct in the preoperative imaging (I-SPD). There were 17 I-BPDs in the 438 consecutive PDs; the incidence of I-BPD is 3.88%. In the former year group, the rate of severe complications of I-BPD and I-SPD is 77.78% and 27.18%, respectively ( = 0.003); the rate of CR-POPF of I-BPD is higher than I-SPD, 55.56% vs. 27.18%, but there were no statistically significant differences. In the latter year group, the rate of severe complications of O-BPD and O-SPD is 50% and 18.36%, and the rate of CR-POPF of O-BPD and O-SPD is 37.5% and 22.22%, respectively; both of them have statistically significant differences, and the -value is 0.003 and 0.006, respectively. In the subgroup analysis, both the rate of severe complications and the rate of CR-POPF of I-BPD were higher than O-BPD, 77.78% vs. 50%, and 55.56% vs. 37.5%, but there were no statistically significant differences in both of them; the -value is 0.174 and 0.434, respectively. Univariate and multivariate analyses showed that BPD was an independent risk factor of CR-POPF.
The incidence of O-BPD in PD is 7.17%, 50% of O-BPDs were I-SPD, and the incidence of I-BPD is 3.88%. BPD is an independent risk factor of CR-POPF. The suture closure method may be a simple, safe, and effective method in dealing with BPD in PD.
本研究旨在探讨胰十二指肠切除术（PD）中双分支胰管（BPD）的发生率，并阐明其对临床相关术后胰瘘（CR-POPF）的影响。
迄今为止，所有关于PD术中BPD的文献均为病例报告，PD中BPD的发生率及其对CR-POPF的影响尚不清楚。
连续438例PD患者被分为两组：前一年组和后一年组。前一年组包括连续215例PD，后一年组包括223例。在后一年组中，我们在PD术中发现16例BPD（术中发现的BPD，O-BPD）；O-BPD的发生率为7.17%。其中，有8例患者在术前影像学检查中发现有BPD（术前影像学检查发现的BPD，I-BPD）。所有I-BPD均为O-BPD；这意味着50%的O-BPD在术前影像学检查中为单支胰管（术前影像学检查发现的单支胰管，I-SPD）。在连续438例PD中，有17例I-BPD；I-BPD的发生率为3.88%。在前一年组中，I-BPD和I-SPD的严重并发症发生率分别为77.78%和27.18%（P = 0.003）；I-BPD的CR-POPF发生率高于I-SPD，分别为55.56%和27.18%，但差异无统计学意义。在后一年组中，O-BPD和O-SPD的严重并发症发生率分别为50%和18.36%，O-BPD和O-SPD的CR-POPF发生率分别为37.5%和22.22%；两者均有统计学差异，P值分别为0.003和0.006。在亚组分析中，I-BPD组的严重并发症发生率和CR-POPF发生率均高于O-BPD组，分别为77.
