Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China.
World J Surg Oncol. 2024 Nov 27;22(1):315. doi: 10.1186/s12957-024-03597-x.
Clinically relevant postoperative pancreatic fistula (CR-POPF) is a common postoperative complication after pancreaticoduodenectomy (PD) and is associated with severe complications. Drainage is an effective method to treat POPF and prevent POPF-related complications. However, controversy still exists about whether different drainage methods reduce the incidence or the severity of POPF after PD.
A closed suction drainage was placed posterior to pancreaticojejunostomy in PD except for other routine drainage placements. A retrospective study was conducted to calculate the incidence and severity of CR-POPF and POPF-related complications and to evaluate the efficacy of this drainage method.
295 patients who underwent PD were enrolled in this study, 130 patients in the trial group and 165 patients in the control group. The two groups were comparable in both preoperative and intraoperative characteristics. The overall incidence of CR-POPF was similar between the two groups. The trial group had a significantly decreased incidence of grade C POPF (0% vs. 3.6%, p < 0.05), post-pancreatectomy hemorrhage (PPH) (0% vs. 6.1%, p = 0.003), reoperation (0% vs. 3.6%, p = 0.036), intra-abdominal infection (13.1% vs. 25.5%, p = 0.008), and delayed gastric emptying (DGE) (2.3% vs. 8.5%, p = 0.024) than the control group. Subgroup analysis of patients with intermediate/high risk for CR-POPF mirrored these results. Logistic regression identified obstructive jaundice, biliary fistula, POPF, and DGE as independent risk factors for PPH and reoperation, though the results were not significant in multivariate analysis.
The drainage posterior to pancreaticojejunostomy reduces the severity of POPF and the incidence of POPF-related complications after PD.
临床相关的术后胰瘘（CR-POPF）是胰十二指肠切除术（PD）后的常见术后并发症，与严重并发症相关。引流是治疗 POPF 和预防 POPF 相关并发症的有效方法。然而，关于 PD 后不同引流方法是否降低 POPF 的发生率或严重程度仍存在争议。
在 PD 中，除了常规引流放置外，在胰肠吻合口后放置封闭式负压引流。进行了一项回顾性研究，以计算 CR-POPF 和 POPF 相关并发症的发生率和严重程度，并评估这种引流方法的疗效。
本研究纳入了 295 例接受 PD 的患者，其中试验组 130 例，对照组 165 例。两组在术前和术中特征方面具有可比性。两组的总体 CR-POPF 发生率相似。试验组 C 级 POPF（0% vs. 3.6%，p < 0.05）、胰切除术后出血（PPH）（0% vs. 6.1%，p = 0.003）、再次手术（0% vs. 3.6%，p = 0.036）、腹腔感染（13.1% vs. 25.5%，p = 0.008）和延迟性胃排空（DGE）（2.3% vs. 8.5%，p = 0.024）的发生率明显低于对照组。对 CR-POPF 中高危患者的亚组分析也得到了类似的结果。Logistic 回归分析确定梗阻性黄疸、胆瘘、POPF 和 DGE 是 PPH 和再次手术的独立危险因素，但多变量分析结果不显著。
胰肠吻合口后引流可降低 PD 后 POPF 的严重程度和 POPF 相关并发症的发生率。
