Abstract：
BACKGROUND: A post-operative pancreatic fistula is a major cause of morbidity and mortality in patients undergoing pancreaticoduodenectomy. We compared two methods of reconstruction of pancreaticojejunal anastomosis, an isolated loop with a single loop, to assess their effects on the incidence and severity of fistula.
METHODS: The data was collected in an ambispective manner. The drain fluid was sent for amylase measurement on post-operative day 3 and a fistula was defined and classified according to the 2016 modification of the International Study Group for Pancreatic Surgery definition. The patients were divided into the isolated (Group I) and single (Group II) loop groups and compared for the incidence and severity of clinically relevant fistula along with other parameters.
RESULTS: A total of 349 (Group I: 201, Group II: 148) patients were included in the study. The incidence of clinically relevant fistula was comparable (p = 0.206). Grade C fistula was found to be lower in the group I (7 % vs 11.6 %, p = 0.137), in patients with a soft pancreas (8.5 % vs 18.3 %, p = 0.049) and pancreatic duct diameter less than 5 mm (9.8 % vs 17.2 %, p = 0.036). The operative time was lower in Group I than in Group II (438 min vs 478, p < 0.001).
CONCLUSIONS: We found that the incidence of clinically relevant fistula was similar in both the groups but the isolated reconstruction method reduced the incidence of severe fistula. In patients with a smaller pancreatic duct, soft pancreas echotexture and obesity, it provides a safer alternative and can be performed in less time than a single loop reconstruction.
METHODS: The data was collected in an ambispective manner. The drain fluid was sent for amylase measurement on post-operative day 3 and a fistula was defined and classified according to the 2016 modification of the International Study Group for Pancreatic Surgery definition. The patients were divided into the isolated (Group I) and single (Group II) loop groups and compared for the incidence and severity of clinically relevant fistula along with other parameters.
RESULTS: A total of 349 (Group I: 201, Group II: 148) patients were included in the study. The incidence of clinically relevant fistula was comparable (p = 0.206). Grade C fistula was found to be lower in the group I (7 % vs 11.6 %, p = 0.137), in patients with a soft pancreas (8.5 % vs 18.3 %, p = 0.049) and pancreatic duct diameter less than 5 mm (9.8 % vs 17.2 %, p = 0.036). The operative time was lower in Group I than in Group II (438 min vs 478, p < 0.001).
CONCLUSIONS: We found that the incidence of clinically relevant fistula was similar in both the groups but the isolated reconstruction method reduced the incidence of severe fistula. In patients with a smaller pancreatic duct, soft pancreas echotexture and obesity, it provides a safer alternative and can be performed in less time than a single loop reconstruction.
摘要：
背景：术后胰瘘是胰十二指肠切除术患者发病和死亡的主要原因。我们比较了两种重建胰肠吻合术的方法，具有单个循环的孤立循环，评估其对瘘管发病率和严重程度的影响。
方法：数据是以相互对照的方式收集的。术后第3天发送引流液进行淀粉酶测量，并根据国际胰腺手术研究小组2016年的修改定义和分类瘘管。将患者分为孤立（I组）和单（II组）环组，并比较临床相关瘘的发生率和严重程度以及其他参数。
结果：共349例（组：201，组：148）患者纳入研究。临床相关瘘的发生率相当（p=0.206）。发现C级瘘管在I组中较低（7％vs11.6％，p=0.137)，在软胰腺患者中（8.5%vs18.3%，p=0.049）和胰管直径小于5毫米（9.8％vs17.2％，p=0.036)。I组的手术时间低于II组（438分钟vs478，p<0.001）。
结论：我们发现两组临床相关瘘的发生率相似，但孤立的重建方法降低了严重瘘的发生率。在胰管较小的患者中，软胰腺回声结构和肥胖，它提供了一种更安全的替代方案，并且可以在比单个环路重建更少的时间内执行。
方法：数据是以相互对照的方式收集的。术后第3天发送引流液进行淀粉酶测量，并根据国际胰腺手术研究小组2016年的修改定义和分类瘘管。将患者分为孤立（I组）和单（II组）环组，并比较临床相关瘘的发生率和严重程度以及其他参数。
结果：共349例（组：201，组：148）患者纳入研究。临床相关瘘的发生率相当（p=0.206）。发现C级瘘管在I组中较低（7％vs11.6％，p=0.137)，在软胰腺患者中（8.5%vs18.3%，p=0.049）和胰管直径小于5毫米（9.8％vs17.2％，p=0.036)。I组的手术时间低于II组（438分钟vs478，p<0.001）。
结论：我们发现两组临床相关瘘的发生率相似，但孤立的重建方法降低了严重瘘的发生率。在胰管较小的患者中，软胰腺回声结构和肥胖，它提供了一种更安全的替代方案，并且可以在比单个环路重建更少的时间内执行。
