Pancreatic Fistula and Delayed Gastric Emptying After Pancreatectomy: Where do We Stand?
Pancreatic Fistula and Delayed Gastric Emptying After Pancreatectomy: Where do We Stand?
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DOI：
10.1007/s12262-015-1366-9
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发表时间：
2015-10-01
影响因子：
0.4
通讯作者：
Wolfgang, Christopher L.
中科院分区：
文献类型：
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作者：
Javed, Ammar A.;Aziz, Kanza;Wolfgang, Christopher L.
胰腺切除术已成为胰腺肿瘤的一种可行的治疗方法，随着手术技术和围手术期管理的改进，与胰腺手术相关的死亡率已大大降低。尽管有这种改善，但这些手术的并发症发生率仍然很高。在这些并发症中，胃排空延迟（DGE）和术后胰瘘（POPF）对患者结局有重大影响，并给我们的医疗保健系统带来负担。已经提出了技术改进和术后方法来降低接受胰腺切除术患者的POPF和DGE发生率;然而，迄今为止，其发生率保持不变。在本研究中，我们总结了调查这些并发症的最重要的研究结果。特别是，几项研究重点关注技术修改，包括夹层程度、支架放置、吻合性质、重建类型以及在吻合部位应用生物或非生物制剂。此外，还研究了术后引流管放置、引流管使用持续时间、术后喂养和药物的使用，以降低POPF和DGE的发生率。在这篇综述中，我们总结了胰腺手术这一基本方面的最相关的文献。尽管研究确定了技术修改和术后方法的潜在益处，但这些发现仍存在争议，并建议需要进一步广泛的调查。最重要的是，我们建议所有执行这些手术的外科医生将其实践建立在最新和最高水平的证据基础上。
Pancreatic resection has become a feasible treatment of pancreatic neoplasms, and with improvements in surgical techniques and perioperative management, mortality associated with pancreatic surgery has decreased considerably. Despite this improvement, a high rate of complications is still associated with these procedures. Among these complications, delayed gastric emptying (DGE) and postoperative pancreatic fistula (POPF) have a substantial impact on patient outcomes and burden our healthcare system. Technical modifications and postoperative approaches have been proposed to reduce rates of both POPF and DGE in patients undergoing pancreatectomy; however, to date, their rates have remained unchanged. In the present study, we summarize the findings of the most significant studies that have investigated these complications. In particular, several studies focused on technical modifications including extent of dissection, stent placement, nature of anastomosis, type of reconstruction, and application of biological or non-biological agents to site of anastomosis. Moreover, postoperatively, drain placement, duration of drain usage, postoperative feeding, and use of pharmacological agents were studied to reduce rates of POPF and DGE. In this review, we summarize the most relevant literature on this fundamental aspect of pancreatic surgery. Despite studies identifying the potential benefit of technical modifications and postoperative approaches, these findings remain controversial and suggest need for further extensive investigation. Most importantly, we recommend that all surgeons performing these procedures base their practice on the most updated and highest available level of evidence.