Robertson Francis P, Spiers Harry V M, Lim Wei Boon, Loveday Benjamin, Roberts Keith, Pandanaboyana Sanjay
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, United Kingdom.
Department of HPB Surgery, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom.
World J Gastrointest Surg. 2023 Aug 27;15(8):1799-1807. doi: 10.4240/wjgs.v15.i8.1799.
Post-operative pancreatic fistula (POPF) is the primary cause of morbidity following pancreaticoduodenectomy. Rates of POPF have remained high despite well known risk factors. The theory that hypoperfusion of the pancreatic stump leads to anastomotic failure has recently gained interest.
To define the published literature with regards to intraoperative pancreas perfusion assessment and its correlation with POPF.
A systematic search of available literature was performed in November 2022. Data extracted included study characteristics, method of assessment of pancreas stump perfusion, POPF and other post-pancreatic surgery specific complications.
Five eligible studies comprised two prospective non-randomised studies and three case reports, total 156 patients. Four studies used indocyanine green fluorescence angiography to assess the pancreatic stump, with the remaining study assessing pancreas perfusion by visual inspection of arterial bleeding of the pancreatic stump. There was significant heterogeneity in the definition of POPF. Studies had a combined POPF rate of 12%; intraoperative perfusion assessment revealed hypoperfusion was present in 39% of patients who developed POPF. The rate of POPF was 11% in patients with no evidence of hypoperfusion and 13% in those with evidence of hypoperfusion, suggesting that not all hypoperfusion gives rise to POPF and further analysis is required to analyse if there is a clinically relevant cut off. Significant variance in practice was seen in the pancreatic stump management once hypoperfusion was identified.
The current published evidence around pancreas perfusion during pancreaticoduodenectomy is of poor quality. It does not support a causative link between hypoperfusion and POPF. Further well-designed prospective studies are required to investigate this.
术后胰瘘（POPF）是胰十二指肠切除术后发病的主要原因。尽管存在众所周知的风险因素，但POPF的发生率仍然很高。胰残端灌注不足导致吻合失败的理论最近引起了关注。
界定关于术中胰腺灌注评估及其与POPF相关性的已发表文献。
于2022年11月对现有文献进行系统检索。提取的数据包括研究特征、胰残端灌注评估方法、POPF及其他胰腺手术后特定并发症。
五项符合条件的研究包括两项前瞻性非随机研究和三项病例报告，共156例患者。四项研究使用吲哚菁绿荧光血管造影评估胰残端，其余一项研究通过肉眼观察胰残端动脉出血来评估胰腺灌注。POPF的定义存在显著异质性。这些研究的POPF综合发生率为12%；术中灌注评估显示，发生POPF的患者中有39%存在灌注不足。无灌注不足证据的患者中POPF发生率为11%，有灌注不足证据的患者中POPF发生率为13%，这表明并非所有灌注不足都会导致POPF，需要进一步分析是否存在临床相关的临界值。一旦发现灌注不足，在胰残端处理方面存在显著的实践差异。
目前关于胰十二指肠切除术中胰腺灌注的已发表证据质量较差。它不支持灌注不足与POPF之间存在因果关系。需要进一步开展设计良好的前瞻性研究来对此进行调查。
