A drainage strategy for postoperative pancreatic fistula after left-sided pancreatectomy based on the wall status of collected fluid.
A drainage strategy for postoperative pancreatic fistula after left-sided pancreatectomy based on the wall status of collected fluid.
复制标题
基于收集液壁状态的左侧胰腺切除术后胰瘘的引流策略。
DOI：
10.1007/s00423-020-02067-8
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Masaki Kuwatani
中科院分区：
文献类型：
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作者：
Takahashi J;Masuda T;Kitagawa A;Tobo T;Nakano Y;Abe T;Ando Y;Kosai K;Kobayashi Y;Matsumoto Y;Yoshizumi T;Mori M;Mimori K.;Masaki Kuwatani
目的胰腺切除术后胰瘘（POPF）是胰腺切除术后严重的不良反应之一。我们的目的是澄清一个战略POPF左侧胰腺切除术后的一步内镜超声引导引流（EUSD）和经皮引流（PCD）的基础上收集fluid.MethodsFrom 2012年1月至2017年9月的壁状态，90级B/C POPF的336例，并进行了回顾性分析。主要结局指标是技术和临床成功率和解决率。次要结局指标是从手术到干预的时间，从干预到出院/解决或支架/管取出和不良事件的时间。Results 17例患者接受EUSD和73例患者接受PCD POPF。EUSD和PCD组的技术成功率均为100%。EUSD组的临床成功率和消退率为100%，而PCD组为98.6%。EUSD组从手术到干预的时间显著长于PCD组（20天vs. 11天，p< 0.001）。EUSD组从干预到出院/消退的时间显著短于PCD组（11天vs. 22天，p< 0.001/10 vs. 20天，p< 0.001）。PCD组从介入到取出支架/管的时间显著短于EUSD组（20.5 vs. 873天，p< 0.001）。两组不良事件发生率相似（11.8% vs.5.5%）。结论根据收集液体的壁状态制定POPF引流策略是适当的。
PurposePostoperative pancreatic fistula (POPF) after pancreatectomy is one of the severe postoperative adverse events. We aimed to clarify the outcomes of a strategy for POPF after left-sided pancreatectomy with one-step endoscopic ultrasonography-guided drainage (EUSD) and percutaneous drainage (PCD) based on the wall status of collected fluid.MethodsFrom January 2012 to September 2017, 90 of 336 patients developed grade B/C POPF and were retrospectively analyzed. Primary outcome measures were the technical and clinical success and resolution rates. Secondary outcome measures were time from surgery to intervention, and time from intervention to discharge/resolution or stent/tube removal and adverse events.ResultsSeventeen patients underwent EUSD and 73 patients underwent PCD for POPF. The technical success rates were 100% in both the EUSD and PCD groups. The clinical success and resolution rates in the EUSD group were 100%, while those in the PCD group were 98.6%. The time from surgery to intervention was significantly longer in the EUSD group than in the PCD group (20 vs. 11 days,p< 0.001). The time from intervention to discharge/resolution was significantly shorter in the EUSD group than in the PCD group (11 vs. 22 days,p< 0.001/10 vs. 20 days,p< 0.001). The time from intervention to stent/tube removal was significantly shorter in the PCD group than in the EUSD group (20.5 vs. 873 days,p< 0.001). Adverse event rates were similar in the two groups (11.8% vs. 5.5%).ConclusionA drainage strategy for POPF based on the wall status of collected fluid is appropriate.