Hamanaka Y, Nishihara K, Hamasaki T, Kawabata A, Yamamoto S, Tsurumi M, Ueno T, Suzuki T
Second Department of Surgery, Yamaguchi University School of Medicine, Japan.
Surgery. 1996 Mar;119(3):281-7. doi: 10.1016/s0039-6060(96)80114-0.
A soft pancreas with a main pancreatic duct (MPD) with normal diameter has been considered a high risk for pancreatic anastomotic leakage because of a relatively high output of pancreatic juice, but data are lacking.
An attempt was made to assess the relationship between the consistency of the pancreas, MPD diameter, pancreatic juice output, and pancreatic leakage after partial pancreatoduodenectomy. The pancreatic parenchyma was classified as of soft, intermediate, and hard consistency in 70 consecutive patients undergoing operation (groups 1, 2, and 3, respectively) by one surgeon. The MPD diameter was determined by means of endoscopic pancreatography or abdominal ultrasonography. Pancreatic juice output was measured for 21 days after operation by using a catheter inserted into the MPD. Anastomotic leakage was identified radiologically by using contrast medium.
The mean (SD) pancreatic juice output during a period of 10 days (postoperative days 5 to 14) was 1554 (1073) ml in group 1 (n = 29), 1513 (1060) ml in group 2 (n = 13), and 187 (220)ml in group 3 (n = 28) (groups 1 and 2 versus group 3, p < 0.0001). The MPD diameter was 3.0 (1.6) mm in group 1, 5.9 (2.5) mm in group 2, and 6.6 (2.6) mm in group 3 (group 1 versus groups 2 and 3, p = 0.0001). Anastomotic leaks occurred in four (14%) patients in group 1, three (23%) in group 2, and none in group 3 (p < 0.05).
Patients with a pancreatic parenchyma with an intermediate or normal consistency produced more pancreatic juice and had a higher leak rate.
由于胰液分泌量相对较高，胰腺质地柔软且主胰管（MPD）直径正常被认为是胰腺吻合口漏的高风险因素，但相关数据匮乏。
试图评估部分胰十二指肠切除术后胰腺质地、MPD直径、胰液分泌量与胰腺漏之间的关系。由一名外科医生对70例连续接受手术的患者的胰腺实质按质地分为软、中等和硬三类（分别为1、2、3组）。通过内镜胰管造影术或腹部超声测定MPD直径。术后通过插入MPD的导管测量21天的胰液分泌量。通过使用造影剂进行放射学检查来确定吻合口漏。
在术后第5至14天的10天期间，1组（n = 29）的平均（标准差）胰液分泌量为1554（1073）ml，2组（n = 13）为1513（1060）ml，3组（n = 28）为187（220）ml（1组和2组与3组相比，p < 0.0001）。1组的MPD直径为3.0（1.6）mm，2组为5.9（2.5）mm，3组为6.6（2.6）mm（1组与2组和3组相比，p = 0.0001）。1组有4例（14%）患者发生吻合口漏，2组有3例（23%），3组无（p < 0.05）。
胰腺实质质地中等或正常的患者胰液分泌更多，漏出率更高。
