Lowy A M, Lee J E, Pisters P W, Davidson B S, Fenoglio C J, Stanford P, Jinnah R, Evans D B
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Ann Surg. 1997 Nov;226(5):632-41. doi: 10.1097/00000658-199711000-00008.
This study was conducted to determine whether the perioperative administration of octreotide decreases the incidence of pancreatic anastomotic leak after pancreaticoduodenectomy for malignancy.
Three multicenter, prospective, randomized trials concluded that patients who receive octreotide during and after pancreatic resection have a reduction in the total number of complications or a decreased incidence of pancreatic fistula. However, in the subset of patients who underwent pancreaticoduodenectomy for malignancy, either no analysis was performed or no benefit from octreotide could be demonstrated.
A single-institution, prospective, randomized trial was conducted between June 1991 and December 1995 involving 120 patients who were randomized to receive octreotide (150 microg subcutaneously every 8 hours through postoperative day 5) or no further treatment after pancreaticoduodenectomy for malignancy. The surgical technique was standardized, and the pancreaticojejunal anastomosis was created using the duct-to-mucosa or invagination technique.
The two patient groups were similar with respect to patient demographics, treatment variables, and histologic diagnoses. The rate of clinically significant pancreatic leak was 12% in the octreotide group and 6% in the control group (p = 0.23). Perioperative morbidity was 30% and 25%, respectively. Patients who underwent reoperative pancreaticoduodenectomy had an increased incidence of pancreatic anastomotic leak, whereas those who received preoperative chemoradiation had a decreased incidence of pancreatic anastomotic leak.
The routine use of octreotide after pancreaticoduodenectomy for malignancy cannot be recommended.
本研究旨在确定围手术期应用奥曲肽是否能降低恶性肿瘤胰十二指肠切除术后胰肠吻合口漏的发生率。
三项多中心、前瞻性、随机试验得出结论，在胰腺切除术中及术后接受奥曲肽治疗的患者并发症总数减少或胰瘘发生率降低。然而，在接受恶性肿瘤胰十二指肠切除术的患者亚组中，要么未进行分析，要么未显示出奥曲肽的益处。
1991年6月至1995年12月在单一机构进行了一项前瞻性随机试验，120例患者被随机分为两组，一组在恶性肿瘤胰十二指肠切除术后接受奥曲肽治疗（术后第5天前每8小时皮下注射150微克），另一组不接受进一步治疗。手术技术标准化，采用导管对黏膜或套入技术进行胰空肠吻合。
两组患者在人口统计学、治疗变量和组织学诊断方面相似。奥曲肽组临床显著胰漏发生率为12%，对照组为6%（p = 0.23）。围手术期发病率分别为30%和25%。接受再次胰十二指肠切除术的患者胰肠吻合口漏发生率增加，而接受术前放化疗的患者胰肠吻合口漏发生率降低。
不推荐在恶性肿瘤胰十二指肠切除术后常规使用奥曲肽。
