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首页> 美国卫生研究院文献>The Surgery Journal >The Effect of Preoperative Biliary and Pancreatic Drainage on Postoperative Pancreatic Fistula: A Retrospective Cohort Study
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The Effect of Preoperative Biliary and Pancreatic Drainage on Postoperative Pancreatic Fistula: A Retrospective Cohort Study

机译：术前胆胰引流对术后胰瘘的影响：一项回顾性队列研究

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>Background  Surgeons and endoscopists welcome routine preoperative biliary drainage prior to pancreaticoduodenectomy despite evidence that it increases complications. Its effect on postoperative pancreatic fistula is variably reported in literature. Simultaneous biliary and pancreatic drainage is rarely performed for very selected indications and its effects on postoperative pancreatic fistula are largely unknown. Our aim was to analyze the same while eliminating confounding factors. >Methods  Retrospective single center cohort study of patients who underwent pancreaticoduodenectomy over the past 10 years for carcinoma obstructing the lower common bile duct. Patients who underwent biliary stenting alone, biliary and pancreatic stenting, and no stenting prior to pancreaticoduodenectomy were the three study cohort groups and their records were scrutinized for the incidence of postoperative pancreatic fistula. >Results  Sixty-two patients underwent biliary stenting alone, 5 patients underwent both biliary and pancreatic stenting, and 237 patients were not stented in the adenocarcinoma group without chronic pancreatitis. The pancreatic fistula rate was similar in the patients who underwent biliary stenting alone when compared with the group which was not stented. (24/62 versus 67/237, odds ratio [OR] =0.619, confidence interval (CI) =0.345–1.112, p  = 0.121). However, the patients who underwent both biliary and pancreatic stenting had a significant increase in postoperative pancreatic fistula compared with the not stented ( p  = 0.003). By univariate and multivariate analysis using Firth logistic regression, pancreatic texture (OR = 1.205, CI = 0.103–2.476, p  = 0.032) and the presence of a biliary and pancreatic stent (OR = 2.695, CI = 0.273–7.617, p  = 0.027) were the significant factors affecting pancreatic fistula.>Conclusion Preoperative biliary drainage alone has no significant influence on postoperative pancreatic fistula except when combined with pancreatic stenting. We need more such studies from other centers to confirm that the rare event of preoperative biliary and pancreatic stenting has indeed this harmful effect on healing of postoperative pancreatic anastomosis.
机译：>背景尽管有证据表明胰十二指肠切除术会增加并发症，但外科医生和内镜医师仍欢迎常规的术前胆道引流。其对术后胰瘘的作用在文献中有不同报道。很少有非常多的适应症同时进行胆道和胰管同时引流，其对术后胰瘘的作用尚不清楚。我们的目的是在消除混淆因素的同时进行分析。 >方法 single回顾性单中心队列研究了过去10年因胰胆管下段癌而行胰十二指肠切除术的患者。这三个研究组分别接受了胆管支架置入术，胆管和胰支架置入术且在胰十二指肠切除术前未进行支架置入术的患者，并仔细检查了他们的记录以了解术后胰瘘的发生率。 >结果 the腺癌组无慢性胰腺炎，其中62例单独行胆道支架置入术，5例同时行胆道和胰腺支架置入术，237例未行支架置入术。与未进行支架置入的患者相比，仅接受胆道支架置入的患者的胰瘘发生率相似。 （24/62对67/237，优势比[OR] = 0.619，置信区间（CI）= 0.345–1.112，p = 0.121）。但是，同时进行胆道和胰支架置入术的患者与未置入支架的患者相比，术后胰瘘显着增加（p increase = 0.003）。通过Firth logistic回归进行单因素和多因素分析，胰腺质地（OR = 1.205，CI = 0.103–2.476，p = 0.032）以及存在胆胰支架（OR = 2.695，CI = 0.273–7.617，p = 0.027 ）是影响胰瘘的重要因素。>结论单独进行术前胆道引流对术后胰瘘无明显影响，除非与胰支架置入术相结合。我们需要来自其他中心的更多此类研究，以确认术前胆胰支架置入术的罕见事件确实对术后胰腺吻合术的愈合具有这种有害作用。

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