胰十二指肠切除术后胰瘘防治的研究进展

Research Progress in Prevention and Treatment of Pancreatic Fistula after Pancreaticoduodenectomy

术后胰瘘(POPF)是胰十二指肠切除术后最常见也是最凶险的并发症,其研究一直是世界范围内的热点,然而POPF的发生率仍未见明显改善,这与其复杂的病理生理学发生机制,缺乏准确的预测手段以及及时、有效的干预措施有关。各国研究团队建立了多种胰瘘预测体系,并根据不同的风险分层预测胰瘘的发生率及严重程度,甄别POPF高危患者后积极采取预防措施。目前,对POPF的预防可从改善营养、决策个体化手术方式等方面进行,而针对B、C级胰瘘应选择多学科综合治疗以提高其治疗效果。未来,应建立可操作性及准确性强的预测体系并制订POPF分层管理方案以优化POPF管理。

Postoperative pancreatic fistula(POPF) is the most common and most dangerous complication after pancreaticoduodenectomy.Its research has been a worldwide hotspot,but the incidence of POSF has not become better significantly,which is related with its complicated pathophysiology and lack of accurate predictive tools as well as effective interventions.Research teams from different nations have established a variety of predictive systems to predict the incidence and severity of pancreatic fistula according to different risk stratifications,and to take prevention for patients at high-risk of POPF.At present,the prevention of POPF can be carried out in terms of improving nutrition and individualized decision-making surgical methods.Multi-disciplinary treatment should be selected for grade B and C pancreatic fistula to improve its therapeutic effect.In the future,a predictive system with strong operability and accuracy should be established and a hierarchical POPF management scheme should be formulated to optimize POPF management.