Sun Yi, Yu Xiao-Feng, Yao Han, Xu Shi, Ma Yu-Qiao, Chai Chen
Department of General Surgery, The People's Hospital of Suzhou New District, Suzhou 215000, Jiangsu Province, China.
World J Gastrointest Surg. 2023 Sep 27;15(9):1901-1909. doi: 10.4240/wjgs.v15.i9.1901.
Pancreatoduodenectomy (PD) is the most effective surgical procedure to remove a pancreatic tumor, but the prevalent postoperative complications, including postoperative pancreatic fistula (POPF), can be life-threatening. Thus far, there is no consensus about the prevention of POPF.
To determine possible prognostic factors and investigate the clinical effects of modified duct-to-mucosa pancreaticojejunostomy (PJ) on POPF development.
We retrospectively collected and analyzed the data of 215 patients who underwent PD between January 2017 and February 2022 in our surgery center. The risk factors for POPF were analyzed by univariate analysis and multivariate logistic regression analysis. Then, we stratified patients by anastomotic technique (end-to-side invagination PJ modified duct-to-mucosa PJ) to conduct a comparative study.
A total of 108 patients received traditional end-to-side invagination PJ, and 107 received modified duct-to-mucosa PJ. Overall, 58.6% of patients had various complications, and 0.9% of patients died after PD. Univariate and multivariate logistic regression analyses showed that anastomotic approaches, main pancreatic duct (MPD) diameter and pancreatic texture were significantly associated with the incidence of POPF. Additionally, the POPF incidence and operation time in patients receiving modified duct-to-mucosa PJ were 11.2% and 283.4 min, respectively, which were significantly lower than those in patients receiving traditional end-to-side invagination PJ (27.8% and 333.2 minutes).
Anastomotic approach, MPD diameter and pancreatic texture are major risk factors for POPF development. Compared with traditional end-to-side invagination PJ, modified duct-to-mucosa PJ is a simpler and more efficient technique that results in a lower incidence of POPF. Further studies are needed to validate our findings and explore the clinical applicability of our technique for laparoscopic and robotic PD.
胰十二指肠切除术（PD）是切除胰腺肿瘤最有效的外科手术，但常见的术后并发症，包括术后胰瘘（POPF），可能危及生命。迄今为止，关于预防POPF尚无共识。
确定可能的预后因素，并研究改良的胰管对黏膜胰空肠吻合术（PJ）对POPF发生的临床效果。
我们回顾性收集并分析了2017年1月至2022年2月在我们手术中心接受PD的215例患者的数据。通过单因素分析和多因素逻辑回归分析来分析POPF的危险因素。然后，我们根据吻合技术（端侧套入式PJ、改良的胰管对黏膜PJ）对患者进行分层，以进行比较研究。
共有108例患者接受传统的端侧套入式PJ，107例接受改良的胰管对黏膜PJ。总体而言，58.6%的患者出现各种并发症，0.9%的患者在PD后死亡。单因素和多因素逻辑回归分析表明，吻合方式、主胰管（MPD）直径和胰腺质地与POPF的发生率显著相关。此外，接受改良的胰管对黏膜PJ的患者的POPF发生率和手术时间分别为11.2%和283.4分钟，显著低于接受传统端侧套入式PJ的患者（27.8%和333.2分钟）。
吻合方式、MPD直径和胰腺质地是POPF发生的主要危险因素。与传统的端侧套入式PJ相比，改良的胰管对黏膜PJ是一种更简单、更有效的技术，可降低POPF的发生率。需要进一步的研究来验证我们的发现，并探索我们的技术在腹腔镜和机器人PD中的临床适用性。
