Breaza Gelu Mihai, Hut Florin Emil, Cretu Octavian, Abu-Awwad Simona-Alina, Abu-Awwad Ahmed, Sima Laurentiu, Dan Radu Gheorghe, Dan Cristina Ana-Maria, Closca Raluca Maria, Zara Flavia
Doctoral School, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
University Clinic of Surgery I, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Medicina (Kaunas). 2025 Feb 24;61(3):391. doi: 10.3390/medicina61030391.
: Preoperative biliary stenting (PBS) is commonly used to manage obstructive jaundice in patients undergoing pylorus-preserving pancreaticoduodenectomy (PPPD). However, the impact of PBS on intestinal barrier function and perioperative complications remains controversial. This study aims to evaluate the effect of PBS on intestinal dysfunction and surgical outcomes, focusing on the influence of the stent duration. : In this prospective cohort study, 235 patients undergoing PPPD for resectable pancreatic neoplasms at Timișoara Municipal Emergency Clinical Hospital (2016-2024) were analyzed. Patients were divided into two groups: those with PBS (n = 98) and without PBS (n = 137). Intestinal barrier function was assessed pre- and postoperatively using biomarkers such as zonulin, fecal calprotectin, and serum lipopolysaccharides (LPS). Perioperative outcomes, including pancreatic fistula, delayed gastric emptying (DGE), infections, and hospital stay, were compared. Additionally, outcomes were stratified based on stent duration (2-3 weeks vs. 3-4 weeks). : PBS was associated with significantly higher levels of zonulin, fecal calprotectin, and serum LPS postoperatively, indicating compromised intestinal barrier function. The stented group had a higher incidence of pancreatic fistulas (Grade B/C: 27.5% vs. 13.1%, < 0.01), DGE (25.5% vs. 13.1%, = 0.008), postoperative infections (34.7% vs. 17.5%, = 0.002), and prolonged hospital stay (16.9 ± 4.2 days vs. 14.5 ± 3.7 days, = 0.019). Prolonged stenting (3-4 weeks) was associated with worse outcomes compared to shorter stenting durations (2-3 weeks), including increased rates of infections, sepsis, and ICU stay ( < 0.05 for all comparisons). : Preoperative biliary stenting is associated with increased intestinal barrier dysfunction, systemic inflammation, and higher rates of perioperative complications following PPPD. Prolonged stenting durations (>3 weeks) further exacerbate these risks. Limiting the PBS duration to 2-3 weeks, alongside optimized perioperative management, may help reduce postoperative morbidity and improve surgical outcomes.
术前胆道支架置入术（PBS）常用于治疗接受保留幽门胰十二指肠切除术（PPPD）患者的梗阻性黄疸。然而，PBS对肠道屏障功能和围手术期并发症的影响仍存在争议。本研究旨在评估PBS对肠道功能障碍和手术结局的影响，重点关注支架置入时间的影响。
在这项前瞻性队列研究中，分析了2016年至2024年在蒂米什瓦拉市急诊临床医院接受PPPD治疗可切除胰腺肿瘤的235例患者。患者分为两组：接受PBS的患者（n = 98）和未接受PBS的患者（n = 137）。术前和术后使用诸如闭合蛋白、粪便钙卫蛋白和血清脂多糖（LPS）等生物标志物评估肠道屏障功能。比较围手术期结局，包括胰瘘、胃排空延迟（DGE）、感染和住院时间。此外，根据支架置入时间（2 - 3周与3 - 4周）对结局进行分层。
PBS与术后闭合蛋白、粪便钙卫蛋白和血清LPS水平显著升高相关，表明肠道屏障功能受损。置入支架组胰瘘发生率更高（B/C级：27.5% 对13.1%，<0.01），DGE发生率更高（25.5% 对13.1%，=0.008），术后感染发生率更高（34.7% 对17.5%，=0.002），住院时间更长（16.9±4.2天对14.5±3.7天，=0.019）。与较短的支架置入时间（2 - 3周）相比，延长支架置入时间（3 - 4周）与更差的结局相关，包括感染、脓毒症发生率增加和入住重症监护病房时间延长（所有比较均<0.05）。
术前胆道支架置入术与PPPD术后肠道屏障功能障碍增加、全身炎症反应以及围手术期并发症发生率升高相关。延长支架置入时间（>3周）会进一步加剧这些风险。将PBS时间限制在2 - 3周，同时优化围手术期管理，可能有助于降低术后发病率并改善手术结局。
