胰十二指肠切除术后胰瘘发生影响因素及处理

Risk factors and treatment of pancreatic fistula after pancreaticoduodenectomy

胰瘘是胰十二指肠切除术后最常见的并发症,严重影响手术疗效和病人预后。认识并了解胰瘘发生的相关危险因素有助于防治胰瘘。目前,影响胰瘘发生的较确切的因素主要有:胰腺质地、胰管直径、原发病的病理类型以及术者的个人经验等。尽管消化道重建的具体吻合方式被认为是影响胰瘘的危险因素,但目前的研究表明各种吻合方式的胰瘘发生率差异并无统计学意义;而多数研究均认为术者的经验和技术水平是术后胰瘘的重要影响因素。因此,吻合质量较吻合方式更重要。选择合适及熟练的方式进行确切吻合才是减少胰瘘发生的有效途径。

Postoperative pancreatic fistula （POPF） is the most common complication after pancreaticoduodenectomy, which has significant impacts on curative effects and prognosis. Understanding the risk factors of POPF could contribute to the prevention and treatment of the complication. The contemporary surgical literature suggests the definite risk factors for POPF development are pancreatic texture, pancreatic duct diameter, pathologic type and surgeon experience. Although anastomostic methods of digestive tract reconstruction are regarded as the risk factors for POPF, the current evidences show no significant difference in POPF incidence irrespective of the methods of pancreatic anastomosis following pancreaticoduodenectomy. Reconstructive techniques and surgeon experience have been considered as statistically significant risk factors for POPF approved by the majority of researches. Therefore, the anastomosis quality is more important than the reconstruction type. The efficacious way to reduce the incidence of POPF is selecting the suitable and skilled technique for pancreatic anastomosis.