Smyrniotis Vasileios, Parasyris Stavros, Gemenetzis Georgios, Margaris Ioannis, Petropoulou Zoe, Papadoliopoulou Maria, Sidiropoulos Theodoros, Dellaportas Dionysios, Vezakis Antonios, Polydorou Andreas, Kokoropoulos Panagiotis, Theodoraki Kassiani, Matsota Paraskevi, Vassiliu Panteleimon, Arkadopoulos Nikolaos
From the Department of Surgery, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Hepatobiliary and Pancreatic Unit, Royal Infirmary Edinburgh, Edinburgh, United Kingdom.
Ann Surg Open. 2022 May 16;3(2):e161. doi: 10.1097/AS9.0000000000000161. eCollection 2022 Jun.
Pancreatic leak after pancreaticoduodenectomy and gut restoration via a single jejunal loop remains the crucial predictor of patients' outcome. Our reasoning that active pancreatic enzymes may be more disruptive to the pancreatojejunostomy prompted us to explore a Roux-en-Y configuration for the gut restoration, anticipating diversion of bile salts away from the pancreatic stump. Our study aims at comparing two techniques regarding the severity of postoperative pancreatic fistula (POPF) and patients' outcome.
The files of 415 pancreaticoduodenectomy patients were retrospectively reviewed. Based on gut restoration, the patients were divided into: cohort A (n = 105), with gut restoration via a single jejunal loop, cohort B (n = 140) via a Roux-en-Y technique assigning the draining of pancreatic stump to the short limb and gastrojejunostomy and bile (hepaticojejunostomy) flow to long limb, and cohort C (n = 170) granting the short limb to the gastric and pancreatic anastomosis, whereas hepaticojejunostomy was performed to the long limp. The POPF-related morbidity and mortality were analyzed.
Overall POPF in cohort A versus cohorts B and C was 19% versus 12.1% and 9.4%, respectively ( = 0.01 A vs B + C). POPF-related morbidity in cohort A versus cohorts B and C was 10.5% versus 7.3% and 6.3%, respectively ( = 0.03 A vs B+C). POPF-related total hospital mortality in cohorts A versus B and C was 1.9% versus 0.8% and 0.59%, respectively ( = 0.02 A vs B+C).
Roux-en-Y configuration showed lower incidence and severity of POPF. Irrespective of technical skill, creating a gastrojejunostomy close to pancreatojejunostomy renders the pancreatic enzymes less active by leaping the bile salts away from the pancreatic duct and providing a lower pH.
胰十二指肠切除术后经单空肠袢进行肠道重建后的胰漏仍是患者预后的关键预测因素。我们推断活性胰酶可能对胰肠吻合口造成更大破坏，这促使我们探索采用 Roux-en-Y 构型进行肠道重建，预期能使胆盐从胰残端引流。我们的研究旨在比较两种技术在术后胰瘘（POPF）严重程度和患者预后方面的差异。
对 415 例胰十二指肠切除术患者的病历进行回顾性分析。根据肠道重建方式，将患者分为：A 组（n = 105），经单空肠袢进行肠道重建；B 组（n = 140），采用 Roux-en-Y 技术，将胰残端引流至短袢，胃空肠吻合和胆汁（肝空肠吻合）流向长袢；C 组（n = 170），将短袢用于胃和胰吻合，而肝空肠吻合至长袢。分析与 POPF 相关的发病率和死亡率。
A 组的总体 POPF 发生率与 B 组和 C 组相比分别为 19%、12.1%和 9.4%（A 组与 B 组 + C 组比较，P = 0.01）。A 组与 B 组和 C 组相比，与 POPF 相关的发病率分别为 10.5%、7.3%和 6.3%（A 组与 B 组 + C 组比较，P = 0.03）。A 组与 B 组和 C 组相比，与 POPF 相关的总住院死亡率分别为 1.9%、0.8%和 0.59%（A 组与 B 组 + C 组比较，P = 0.02）。
Roux-en-Y 构型显示出较低的 POPF 发生率和严重程度。无论技术水平如何，在靠近胰肠吻合口处进行胃空肠吻合可通过使胆盐远离胰管并提供较低的 pH 值，降低胰酶活性。
