Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu County, Taiwan, ROC.
Ann Surg Oncol. 2023 Aug;30(8):5063-5070. doi: 10.1245/s10434-023-13114-1. Epub 2023 Feb 18.
Postoperative pancreatic fistulas (POPFs) are considered inevitable in some patients after pancreaticoduodenectomy (PD), and measures to minimize their clinical impact are needed. Postpancreatectomy hemorrhage (PPH) and intra-abdominal abscess (IAA) are the most severe POPF-related complications, and concomitant leakage of contaminated intestinal content is considered the main cause. An innovative method, modified non-duct-to-mucosa pancreaticojejunostomy (TPJ), was created to prevent concomitant leakage of intestinal content, and its effectiveness was compared between two periods.
All PD patients undergoing pancreaticojejunostomy from 2012 to 2021 were included. The TPJ group consisted of 529 patients recruited from January 2018 to December 2021. A total of 535 patients receiving the conventional method (CPJ) from January 2012 to June 2017 were used as a control group. PPH and POPF were defined according to the International Study Group of Pancreatic Surgery definition, but only PPH grade C was included for analysis. An IAA was defined as a collection of postoperative fluid managed by CT-guided drainage with documental culture.
There were no significant differences in the rate of POPF between the two groups (46.0% vs. 44.8%; p = 0.700). Furthermore, the percentages of bile in the drainage fluid in the TPJ and CPJ groups were 2.3% and 9.2%, respectively (p < 0.001). Lower proportions of PPH (0.9% vs. 6.5%; p < 0.001) and IAA (5.7% vs. 10.8%; p < 0.001) were observed for TPJ than for CPJ. On adjusted models, TPJ was significantly associated with a lower rate of PPH (odds ratio [OR] 0.132, 95% confidence interval [CI] 0.051-0.343; p < 0.001) and IAA (OR 0.514, 95% CI 0.349-0.758; p = 0.001) than CPJ.
TPJ is feasible to be performed and is associated with a similar rate of POPF but a lower percentage of concomitant bile in the drainage fluid and subsequent rates of PPH and IAA than CPJ.
胰十二指肠切除术（PD）后，一些患者术后会发生胰瘘（POPF），需要采取措施将其临床影响降至最低。术后出血（PPH）和腹腔脓肿（IAA）是最严重的与 POPF 相关的并发症，而被污染的肠内容物的同时泄漏被认为是主要原因。一种创新的方法，改良非导管-黏膜胰肠吻合术（TPJ），被创建以防止肠内容物的同时泄漏，并比较了两种时期的有效性。
纳入 2012 年至 2021 年期间接受胰肠吻合术的所有 PD 患者。TPJ 组包括 2018 年 1 月至 2021 年 12 月期间招募的 529 名患者。2012 年 1 月至 2017 年 6 月期间接受常规方法（CPJ）的 535 名患者作为对照组。PPH 和 POPF 根据国际胰腺外科研究组织的定义进行定义，但仅对 PPH C 级进行分析。IAA 定义为术后液体经 CT 引导引流管理并经文件记录培养的收集。
两组之间的 POPF 发生率无显著差异（46.0%比 44.8%；p=0.700）。此外，TPJ 组和 CPJ 组引流液中胆汁的比例分别为 2.3%和 9.2%（p<0.001）。TPJ 组的 PPH（0.9%比 6.5%；p<0.001）和 IAA（5.7%比 10.8%；p<0.001）的比例较低。在调整后的模型中，与 CPJ 相比，TPJ 与较低的 PPH（比值比[OR]0.132，95%置信区间[CI]0.051-0.343；p<0.001）和 IAA（OR 0.514，95%CI 0.349-0.758；p=0.001）发生率相关。
TPJ 是可行的，与 CPJ 相比，其发生 POPF 的发生率相似，但引流液中胆汁的比例较低，随后发生 PPH 和 IAA 的发生率也较低。
