应用大网膜衬垫技术预防腹腔镜胰十二指肠切除术后胰瘘及相关并发症研究

Application of an omental pad to reduce pancreatic fistula and related complications in laparoscopic pancreaticoduodenectomy: A propensity score-matched study

目的 探讨大网膜衬垫技术在降低腹腔镜胰十二指肠切除术(LPD)后胰瘘及相关并发症发生率的应用。方法 回顾性分析2018年1月至2021年12月复旦大学附属华东医院普外科实施的88例LPD病人的临床资料。采用倾向性评分匹配(PSM)法对网膜衬垫组(采用大网膜衬垫技术)和对照组(未采用大网膜衬垫技术)进行2∶1匹配,网膜衬垫组获得38例病人,对照组获得19例病人,比较匹配后两组相关临床指标。结果 网膜衬垫组在B、C级胰瘘发生率(10.5%vs. 26.3%),术后迟发性出血(2.6%vs. 10.5%)以及术后感染率(0 vs. 21.1%)低于对照组(P<0.05)。单因素分析显示,BMI、血清清蛋白、大网膜衬垫技术以及术后第1天胰肠侧引流液淀粉酶与LPD术后胰瘘发生相关;多因素分析显示,BMI≥23、血清清蛋白<35 g/L和未应用网膜垫是LPD术后胰瘘发生的独立危险因素。结论 大网膜衬垫技术可有效减少LPD术后胰瘘、出血及其相关严重并发症的发生,提高围手术期安全性。

ObjectiveTo investigate the safety and feasibility of omental pads to reduce the pancreatic fistula rate andrelated complications in laparoscopic pancreaticoduodenectomy(LPD).MethodsThe clinical data of 88 consecutivepatients underwent LPD in the Department of General Surgery of Huadong Hospital affiliated to Fudan Universitybetween January 2018 and December 2021 were collected and analyzed retrospectively. A 2∶1 propensity score-matched(PSM) analysis were performed to compare the clinical data between the omental pad group(using omental padtechnology, 38 cases) and control group(not using omental pad technology, 19 cases).ResultsFollowing PSM, theclinically relevant postoperative pancreatic fistula(CR-POPF;10.5% vs. 26.3%), delayed postpancreatectomyhemorrhage(2.6% vs. 10.5%) rates and infections of post-operation(0 vs. 21.1%) were significantly lower in the omentalpad group(All P<0.05). According to the result of univariate factor analysis, BMI, serum albumin, omental-pad anddrain fluid amylase obtained on postoperative day1(DFA1) around the pancreatojejunostomy(PJ) site were related to thepostoperative pancreatic fistula. High body mass index(BMI≥23), low serum albumin(<35 g/L), and nonapplication ofomental pad were independent risk factors for CR-POPF in the multivariate factors analysis(P<0.05).ConclusionTheapplication of the omental pad is an effective and safe approach to reduce the CR-POPF rate and related complicationsafter LPD and improve the perioperative safety.