Meierhofer Clara, Fuegger Reinhold, Biebl Matthias, Schoefl Rainer
Department of Gastroenterology, Ordensklinikum Linz, 4010 Linz, Austria.
Department of Surgery, Ordensklinikum Linz, 4010 Linz, Austria.
J Clin Med. 2023 Jul 31;12(15):5046. doi: 10.3390/jcm12155046.
Pancreatic fistulas are highly feared complications following surgery on or near the pancreas, abdominal trauma, or severe inflammation. These fistulas arise from leaks in the pancreatic ductal system, leading to various complications such as abscesses, delayed gastric emptying, and hemorrhage. Severe cases present with sepsis or organ failure, dramatically increasing mortality and morbidity. Risk factors include smoking, high BMI, male gender, age, and surgery-related factors like prolonged operation time and non-ligation of the main pancreatic duct. Therefore, treatment options and preventive measurements have become a hot topic in recent years. Studies have investigated the use of fibrin sealants, different closure methods, and less invasive surgical techniques. Treatment options consist of conservative measurements and the use of percutaneous drainage, prophylactic transpapillary stenting, and surgery in severe cases. As EUS has become widely available, transmural stenting started to influence the management of pancreatic fluid collections (PFCs). However, studies on its use for the management of pancreatic fistulas are lacking. Medical treatment options like somatostatin analogs and pasireotide have been investigated but yielded mixed results.
胰瘘是胰腺及其附近手术、腹部创伤或严重炎症后令人高度恐惧的并发症。这些瘘源于胰管系统的渗漏，会导致各种并发症，如脓肿、胃排空延迟和出血。严重病例会出现脓毒症或器官衰竭，显著增加死亡率和发病率。风险因素包括吸烟、高体重指数、男性、年龄以及手术相关因素，如手术时间延长和主胰管未结扎。因此，治疗方案和预防措施近年来已成为热门话题。研究已经探讨了纤维蛋白密封剂的使用、不同的闭合方法以及侵入性较小的手术技术。治疗方案包括保守措施以及在严重情况下使用经皮引流、预防性经乳头支架置入术和手术。随着超声内镜检查（EUS）的广泛应用，经壁支架置入术开始影响胰液积聚（PFC）的管理。然而，关于其用于胰瘘管理的研究却很缺乏。像生长抑素类似物和帕西瑞肽这样的药物治疗方案已经过研究，但结果不一。
