摘要
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.
引文
[1]Whipple AO,Parsons WB,Mullins CR.Treatment of carcinoma of the ampulla of vater[J].Ann Surg,1935,102(4):763-779.
[2]Roberts KJ,Hodson J,Mehrzad H,et al.A preoperative predictive score of pancreatic fistula following pancreatoduodenectomy[J].HPB(Oxford),2014,16(7):620-628.
[3]Bassi C,Dervenis C,Butturini G,et al.Postoperative pancreatic fistula:An international study group(ISGPF)definition[J].Surgery,2005,138(1):8-13.
[4]Bassi C,Marchegiani G,Dervenis C,et al.The 2016 update of the International Study Group(ISGPS)definition and grading of postoperative pancreatic fistula:11 years after[J].Surgery,2017,161(3):584-591.
[5]韩显林,徐竞,吴文铭,等.2016新版胰瘘定义和分级系统对胰腺术后胰瘘评价的影响[J].中华外科杂志,2017,55(7):528-531.
[6]黄建军,陈益君.胰肠吻合术后胰瘘定性诊断的临床价值[J].中华肝胆外科杂志,2017,23(10):700-701.
[7]Connor S.Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection[J].HPB(Oxford),2016,18(8):642-651.
[8]Wellner UF,Kayser G,Lapshyn H,et al.A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively[J].HPB(Oxford),2010,12(10):696-702.
[9]Sato N,Tamura T,Minagawa N,et al.Preoperative body mass index-to-prognostic nutritional index ratio predicts pancreatic fistula after pancreaticoduodenectomy[J].Hepatobiliary Surg Nutr,2016,5(3):256-262.
[10]Yamamoto Y,Sakamoto Y,Nara S,et al.A preoperative predictive scoring system for postoperative pancreatic fistula after pancreaticoduodeneetomy[J].World J Surg,2011,35(12):2747-2755.
[11]陈依然,田孝东,谢学海,等.胰十二指肠切除术后胰瘘风险预测系统的建立和应用[J].中华外科杂志,2016,54(1):39-43.
[12]Callery MP,Pratt WB,Kent TS,et al.A Prospectively validated clinical risk score accurately predicts pancreatic fistula after panereatoduodenectomy[J].J Am Coil Surg,2013,216(1):1-14.
[13]Gaujoux S,Coaes A,Couvelard A,et al.Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after panereaticoduodenectomy[J].Surgery,2010,148(1):15-23.
[14]杨美文,邓永,黄涛,等.胰十二指肠切除术后胰瘘与胰腺纤维化程度相关关系的临床研究[J].中华外科杂志,2017,55(5):373-377.
[15]余淼,王亚东,薛焕洲,等.术前CT指标预测胰十二指肠切除术后胰瘘风险的可行性分析[J].中华医学杂志,2017,97(30):2362-2365.
[16]彭斌,黄强,林先盛,等.胰瘘风险评分系统在胰十二指肠切除术后胰瘘评估中的价值[J].中华肝胆外科杂志,2017,23(2):104-109.
[17]Mc Millan MT,Soi S,Asbun HJ,et al.Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy:A model for performance evaluation[J].Ann Surg,2016,264(2):344-352.
[18]Shubert CR,Wagie AE,Farnell MB,et al.Clinical risk score to predict pancreatic fistula after pancreatoduodenectomy:Independent external validation for open and laparoscopic approaches[J].J Am Coll Surg,2015,221(3):689-698.
[19]Jin S,Shi XJ,Wang SY,et al.Drainage fluid and serum amylase levels accurately predict development of postoperative pancreatic fistula[J].World J Gastroenterol,2017,23(34):6357-6364.
[20]Yamashita S,Ishizawa T,Mori K,et al.Pancreatic chymotrypsin activity rather than amylase level better predicts postoperative pancreatic fistula[J].Ann Surg,2017[2018-12-20].https://insights.ovid.com/pubmed pmid=29135497.[published online ahead of print Nov 13,2017].
[21]Giardino A,Spolverato G,Regi P,et al.C-reactive protein and procalcitonin as predictors of postoperative inflammatory complications after pancreatic surgery[J].J Gastrointest Surg,2016,20(8):1482-1492.
[22]中华医学会外科学分会胰腺外科学组中国研究型医院学会胰腺病专业委员会中华外科杂志编辑部.胰腺术后外科常见并发症诊治及预防的专家共识(2017)[J].中华外科杂志,2017,55(5):328-334.
[23]Ekstr9m E,Ansari D,Williamsson C,et al.Impact of body constitution on complications following pancreaticoduodenectomy:Aretrospective cohort study[J].Int J Surg,2017,48:116-121.
[24]Nishida Y,Kato Y,Kudo M,et al.Preoperative sarcopenia strongly in fluences the risk of postoperative pancreatic fistula formation after pancreaticoduodenectomy[J].J Gastrointest Surg,2016,20(9):1586-1594.
[25]Weimann A,Braga M,Harsanyi L,et al.ESPEN guidelines on enteral nutrition:Surgery including organ transplantation[J].Clin Nutr,2006,25(2):224-244.
[26]Weimann A,Braga M,Carli F,et al.ESPEN guideline:Clinical nutrition in surgery[J].Clin Nutr,2017,36(3):623-650.
[27]Perinel J,Mariette C,Dousset B,et al.Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy:A randomized multicenter controlled trial(Nutri-DPC)[J].Ann Surg,2016,264(5):731-737.
[28]Czosnyka NM,Borgert AJ,Smith TJ.Pancreatic adenocarcinoma:Effects of neoadjuvant therapy on post-pancreatectomy outcomes-an American College of Surgeons National Surgical Quality Improvement Program targeted variable review[J].HPB(Oxford),2017,19(10):927-932.
[29]Heinrich S,Schfer M,Weber A,et al.Neoadjuvant chemotherapygenerates a significant tumor response in resectable pancreatic cancer without increasing morbidity:Results of a prospective phaseⅡtrial[J].Ann Surg,2008,248(6):1014-1022.
[30]Takahashi H,Ogawa H,Ohigashi H,et al.Preoperative chemoradiation reduces the risk of pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma[J].Surgery,2011,150(3):547-556.
[31]Williams ST,Woltering EA,O'Dorisio TM,et al.Effect of octreotide acetate on pancreatic exocrine function[J].Am J Surg,1989,157(5):459-462.
[32]Lowy AM,Lee JE,Pisters PW,et al.Prospective,randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease[J].Ann Surg,1997,226(5):632-641.
[33]Closset J,Journe S,Mboti F,et al.Randomized controlled trial comparing somatostatin with octreotide in the prevention of complications after pancreatectomy[J].Hepatogastroenterology,2008,55(86/87):1818-1823.
[34]Allen PJ,G9nen M,Brennan MF,et al.Pasireotide for postoperative pancreatic fistula[J].N Engl J Med,2014,370(21):2014-2022.
[35]Keck T,Wellner UF,Bahra M,et al.Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy(RECOPANC,DRKS 00000767):Perioperative and long-term results of a multicenter randomized controlled trial[J].Ann Surg,2016,263(3):440-449.
[36]Que W,Fang H,Yan B,et al.Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy:A meta-analysis of randomized controlled trials[J].Am J Surg,2015,209(6):1074-1082.
[37]Borel F,Ouaissi M,Merdrignac A,et al.Pancreatico-jejunostomydecreases post-operative pancreatic fistula incidence and severity after central pancreatectomy[J].ANZ J Surg,2018,88(1/2):77-81.
[38]Senda Y,Shimizu Y,Natsume S,et al.Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy[J].Br J Surg,2018,105(1):48-57.
[39]Shrikhande SV,Sivasanker M,Vollmer CM,et al.Pancreatic anastomosis after pancreatoduodenectomy:A position statement by the International Study Group of Pancreatic Surgery(ISGPS)[J].Surgery,2017,161(5):1221-1234.
[40]Sachs TE,Pratt WB,Kent TS,et al.The pancreaticojejunal anastomotic stent:Friend or foe?[J].Surgery,2013,153(5):651-662.
[41]Ecker BL,Mc Millan MT,Asbun HJ,et al.Characterization and optimal management of high-risk pancreatic anastomoses during pancreatoduodenectomy[J].Ann Surg,2018,267(4):608-616.
[42]Jang JY,Chang YR,Kim SW,et al.Randomized multicentre trial comparing external and internal pancreatic stenting during pancreaticoduodenectomy[J].Br J Surg,2016,103(6):668-675.
[43]余安,黄强,刘臣海,等.胰十二指肠切除术中应用胰管支撑管内外引流的Meta分析[J].中华胰腺病杂志,2017,17(1):48-52.
[44]Witzigmann H,Diener MK,Kienk9tter S,et al.No need for routine drainage after pancreatic head resection:The dual-center,randomized,controlled PANDRA trial(ISRCTN04937707)[J].Ann Surg,2016,264(3):528-537.
[45]Bassi C,Molinari E,Malleo G,et al.Early versus late drain removal after standard pancreatic resections:Results of a prospective randomized trial[J].Ann Surg,2010,252(2):207-214.
[46]Halloran CM,Ghaneh P,Bosonnet L,et al.Complications of pancreatic cancer resection[J].Dig Surg,2002,19(2):138-146.
[47]Giovannini M.Endoscopic ultrasound-guided drainage of pancreatic fluid collections[J].Gastrointest Endosc Clin N Am,2018,28(2):157-169.
[48]Tjaden C,Hinz U,Hassenpflug M,et al.Fluid collection after distal pancreatectomy:A frequent finding[J].HPB(Oxford),2016,18(1):35-40.
[49]Schfer M,Heinrich S,Pfammatter T,et al.Management of delayed major visceral arterial bleeding after pancreatic surgery[J].HPB(Oxford),2011,13(2):132-138.
[50]Khalsa BS,Imagawa DK,Chen JI,et al.Evolution in the treatment of delayed postpancreatectomy hemorrhage:Surgery to interventional radiology[J].Pancreas,2015,44(6):953-958.
[51]Wolk S,Grützmann R,Rahbari NN,et al.Management of clinically relevant postpancreatectomy hemorrhage(PPH)over two decades-Acomparative study of 1 450 consecutive patients undergoing pancreatic resection[J].Pancreatology,2017,17(6):943-950.
