Papachristou D N, Fortner J G
Br J Surg. 1981 Apr;68(4):238-40. doi: 10.1002/bjs.1800680406.
The incidence of pancreatic fistula in a series of 178 pancreatic resections was 25 per cent and was influenced by the type of pancreatectomy, the management of the remaining pancreas and the size of the pancreatic duct. Thus, fistulas appeared in 52 per cent of patients undergoing pancreatoduodenectomy as compared to only 7 per cent of those undergoing distal pancreatectomy (P less than 0.001). Ligation of the pancreatic, duct in pancreatoduodenectomy led to a 70 per cent incidence; the incidence was 33 per cent if the pancreas was anastomosed to the jejunum instead (P less than 0.001). Fistulas were rare in patients who had dilated pancreatic ducts. Fistulas, once they were established, were rarely influenced by treatment. One out of 5 patients developing pancreatic fistula died, while fistulas were responsible for half of the operative deaths. The study indicated that pancreatojejunostomy is safe in the presence of ductal dilatation; it does not, however, protect from fistula if the pancreatic duct is normal. It also indicated that radiation of the pancreatic remnant in selected patients with persistent fistulas might be a useful therapeutic alternative.
在178例胰腺切除术患者中，胰瘘发生率为25%，其受胰腺切除术类型、剩余胰腺的处理方式以及胰管大小的影响。因此，胰十二指肠切除术患者中胰瘘发生率为52%，而远端胰腺切除术患者中仅为7%（P<0.001）。胰十二指肠切除术中结扎胰管导致发生率为70%；若将胰腺与空肠吻合，发生率则为33%（P<0.001）。胰管扩张的患者中胰瘘少见。胰瘘一旦形成，很少受治疗影响。发生胰瘘的患者中五分之一死亡，且胰瘘占手术死亡病例的一半。该研究表明，在胰管扩张时胰空肠吻合术是安全的；然而，如果胰管正常，它并不能预防胰瘘。研究还表明，对部分持续性胰瘘患者的胰腺残端进行放疗可能是一种有效的治疗选择。
