Stenting and the rate of pancreatic fistula following pancreaticoduodenectomy.
Stenting and the rate of pancreatic fistula following pancreaticoduodenectomy.
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DOI：
10.1001/archsurg.2011.850
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发表时间：
2012-01
影响因子：
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通讯作者：
T. Moriya;C. Clark;Yujiro Kirihara;M. Kendrick;K. R. Reid Lombardo;F. Que;M. Farnell
中科院分区：
文献类型：
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作者：
T. Moriya;C. Clark;Yujiro Kirihara;M. Kendrick;K. R. Reid Lombardo;F. Que;M. Farnell
目的 评价经吻合胰管内支架置入术减少胰十二指肠切除术后胰瘘（POPF）的疗效。设计回顾性研究。设置梅奥诊所。患者 1999年1月1日至2010年9月30日期间，553名患者由一名外科医生接受了胰十二指肠切除术。主要观察指标 支架组和无支架组之间的 POPF 发生率、发病率和死亡率。结果 支架组和无支架组的临床相关 POPF（国际胰瘘研究组定义 B 级或 C 级）发生率相似（分别为 9.6% [449 名患者中的 43 名] 和 12.5% [104 名患者中的 13 名]；P = .38）。两组之间的术后结果和发病率也相似。支架组的死亡率为 0.7%（449 名患者中的 3 名），无支架组的死亡率为 1.0%（104 名患者中的 1 名）。 4 名患者 (0.9%) 需要通过内镜取出吻合支架。在子集分析中，小胰管（≤3 mm；n = 167）患者的临床相关 POPF 率在支架组和无支架组中相似（分别为 17.7% [130 名患者中的 23 名] 和 24.3% [37 名患者中的 9 名]；P = .38）。在软胰腺患者 (n = 64) 中，支架组和无支架组的临床相关胰瘘发生率也相似（分别为 31.7% [41 名患者中的 13 名] 和 17.4% [23 名患者中的 4 名]；P = .20）。结论 经吻合胰管内支架置入术不会降低 POPF 的发生频率或严重程度。支架置入术对长期吻合口通畅的影响值得进一步研究。
OBJECTIVE To evaluate the efficacy of transanastomotic pancreatic duct internal stenting in the reduction of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. DESIGN Retrospective study. SETTING Mayo Clinic. PATIENTS Between January 1, 1999, and September 30, 2010, 553 patients underwent pancreaticoduodenectomy by a single surgeon. MAIN OUTCOME MEASURES Rates of POPF, morbidity, and mortality between stent and no-stent groups. RESULTS The clinically relevant POPF (International Study Group on Pancreatic Fistula definition grade B or C) rates in the stent and no-stent groups were similar (9.6% [43 of 449 patients] and 12.5% [13 of 104 patients], respectively; P = .38). Postoperative outcomes and morbidity were also similar between the 2 groups. Mortality was 0.7% (3 of 449 patients) for the stent group and 1.0% (1 of 104 patients) for the no-stent group. Four patients (0.9%) required endoscopic retrieval of the anastomotic stent. In subset analysis, the clinically relevant POPF rates in patients with a small pancreatic duct (≤3 mm; n = 167) were similar in the stent and no-stent groups (17.7% [23 of 130 patients] and 24.3% [9 of 37 patients], respectively; P = .38). In patients with a soft pancreatic gland (n = 64), rates of clinically relevant pancreatic fistulae were also similar in the stent and no-stent groups (31.7% [13 of 41 patients] and 17.4% [4 of 23 patients], respectively; P = .20). CONCLUSIONS Internal transanastomotic pancreatic duct stenting does not decrease the frequency or severity of POPF. The effect of stenting on long-term anastomotic patency warrants further investigation.