Pancreatic fistula after distal pancreatectomy - Predictive risk factors and value of conservative treatment
Pancreatic fistula after distal pancreatectomy - Predictive risk factors and value of conservative treatment
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DOI：
10.1001/archsurg.141.11.1071
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发表时间：
2006-11-01
影响因子：
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通讯作者：
Belghiti, Jacques
中科院分区：
文献类型：
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作者：
Pannegeon, Virginie;Pessaux, Patrick;Belghiti, Jacques
假设：胰瘘（PF）的预测因素和PF的保守治疗的价值远端pancreatectomy（DP）知之甚少。设计：病例系列。设置：一所大学医院转诊center.Patients：从1991年至2003年，175例患者进行DP与常规引流的胰腺残端和术后重复测量引流液。胰瘘定义为术后第5天手术引流液中淀粉酶水平超过血清水平的5倍，或富含淀粉酶的液体收集。仅在怀疑腹部积液时进行计算机断层扫描。PF的保守治疗包括经皮腹腔积液引流和全肠外营养或维持低容量PF患者的口服喂养。干预：DP后PF的保守治疗。根据适应症、伴随脾切除术、附加手术、实质质地、横断位置确定的PF发生率结果：本组病例无死亡率。40例患者（23%）发生PF，其中25例患者（63%）有症状;计算机断层扫描发现26例（65%）腹部积液。多变量分析确定了PF的2个预测因素：未选择性结扎主胰管（比值比，2.2 [95%置信区间，1.0-4.7]）和体部横断（比值比，2.1 [95%置信区间，1.1-5.5]）。如果没有或两个预测因素都存在，PF的观察率分别为16%和63%。胰瘘保守治疗38例（95%），其中经皮穿刺引流16例，再次手术2例。胰腺残端的常规引流不能防止术后腹腔积液。PF保守治疗的成功率为95%。
Hypothesis: Predictive factors of pancreatic fistula (PF) and the value of conservative management of PF following distal pancreatectomy (DP) are poorly known.Design: Case series.Setting: A university hospital referral center.Patients: From 1991 to 2003, 175 patients underwent DP with routine drainage of the pancreatic stump and postoperative repeated measures in drainage fluid. Pancreatic fistula was defined as an amylase level in surgical drainage fluid more than 5-fold the serum level after postoperative day 5, or amylase-rich fluid collection. Computed tomographic scan was only done for suspicion of abdominal collection. Conservative management of PF included percutaneous drainage of abdominal collection and total parenteral nutrition or maintaining oral feeding in some patients with low-volume PF.Intervention: Conservative management of PF after DP.Main Outcome Measures: incidence of PF according to indication, concomitant splenectomy, additional procedure, texture of parenchyma, location of transection (neck vs body), and technique of stump suture (stapler vs hand sewn), including elective ligation of the main duct, transfusions, and prophylactic use of octreotide.Results: There was no mortality. Forty patients (23%) developed PF, which was symptomatic in 25 patients (63%); computed tomographic scan identified an abdominal collection in 26 (65%). Multivariate analysis identified 2 predictive factors for PF: no elective ligation of the main pancreatic duct (odds ratio, 2.2 [95% confidence interval, 1.0-4.7]) and transection at the body (odds ratio, 2.1 [95% confidence, interval, 1.1-5.5]). If none or both predictive factors were present, the observed rate of PF was 16% and 63%, respectively. Pancreatic fistula was managed conservatively in 38 patients (95%), including percutaneous drainage in 16, and by reoperation in 2.Conclusions: Pancreatic fistula following DP is more frequent in cases of pancreatic division at the body level and no elective ligation of the main duct. Routine drainage of the pancreatic stump does not prevent postoperative abdominal collections. Conservative management of PF is successful in 95% of cases.