Abstract：
BACKGROUND: Meta-analysis of 10 randomized prospective trials demonstrated a higher risk of postoperative bleeding from pancreaticogastrostomy (PG) compared with pancreatojejunostomy following pancreatoduodenectomy (PD). This study evaluated the incidence, risk factors, and treatment of anastomotic bleeding from invaginated PG.
METHODS: We retrospectively evaluated all consecutive PDs performed between April 1, 2011 and December 31, 2022 using invaginated PG by the double purse-string technique. Multivariate analysis identified risk factors for anastomotic PG bleeding.
RESULTS: During the study, 695 consecutive patients with a median age of 66 years underwent PD; the majority was performed for ductal pancreatic adenocarcinomas. Simultaneous vascular resections were performed in 328 patients. Postoperative mortality was 4.1%. Bleeding from PG occurred in 33(4.6%) patients at a median interval of 5 days (range, 1-14) from surgery, leading to reoperation in 21(63%). PG bleeding-related mortality was 9.0%. Multivariate analyses identified a soft pancreatic texture and Wirsung duct > 3 or ≤ 3 mm (Class C and D, respectively, of the ISGPS) (odds ratio [OR]: 2.17, 95% confidence interval [95% CI]: 1.38-3.44; P = 0.0009) and wrapping of the invaginated pancreas (OR: 0.37, 95% CI: 0.17-0.84; P = 0.01) as independent risk factors for PG bleeding.
CONCLUSIONS: In a large volume setting, anastomotic bleeding from invaginated PG occurred in ~ 5% of patients and was associated with soft pancreatic parenchyma and small wirsung duct. The reduced rate of PG bleeding observed with wrapping of the invaginated pancreatic stump warrants further evaluation in a prospective randomized study.
METHODS: We retrospectively evaluated all consecutive PDs performed between April 1, 2011 and December 31, 2022 using invaginated PG by the double purse-string technique. Multivariate analysis identified risk factors for anastomotic PG bleeding.
RESULTS: During the study, 695 consecutive patients with a median age of 66 years underwent PD; the majority was performed for ductal pancreatic adenocarcinomas. Simultaneous vascular resections were performed in 328 patients. Postoperative mortality was 4.1%. Bleeding from PG occurred in 33(4.6%) patients at a median interval of 5 days (range, 1-14) from surgery, leading to reoperation in 21(63%). PG bleeding-related mortality was 9.0%. Multivariate analyses identified a soft pancreatic texture and Wirsung duct > 3 or ≤ 3 mm (Class C and D, respectively, of the ISGPS) (odds ratio [OR]: 2.17, 95% confidence interval [95% CI]: 1.38-3.44; P = 0.0009) and wrapping of the invaginated pancreas (OR: 0.37, 95% CI: 0.17-0.84; P = 0.01) as independent risk factors for PG bleeding.
CONCLUSIONS: In a large volume setting, anastomotic bleeding from invaginated PG occurred in ~ 5% of patients and was associated with soft pancreatic parenchyma and small wirsung duct. The reduced rate of PG bleeding observed with wrapping of the invaginated pancreatic stump warrants further evaluation in a prospective randomized study.
摘要：
背景：10项随机前瞻性试验的Meta分析显示，与胰十二指肠切除术（PD）后的胰空肠吻合术相比，胰胃吻合术（PG）术后出血的风险更高。这项研究评估了发病率，危险因素，内陷PG吻合口出血的治疗。
方法：我们回顾性评估了2011年4月1日至2022年12月31日之间使用双荷包技术内陷PG进行的所有连续PD。多因素分析确定了吻合口PG出血的危险因素。
结果：在研究期间，695名中位年龄为66岁的连续患者接受了PD;大多数是针对导管胰腺腺癌进行的。同时行血管切除328例。术后死亡率为4.1%。33例（4.6％）患者发生PG出血，中位间隔为5天（范围，1-14）来自手术，导致21人(63%)再次手术。PG出血相关死亡率为9.0%。多变量分析确定了软胰腺结构和Wirsung导管>3或≤3mm(C类和D类,分别,ISGPS）（比值比[OR]：2.17，95％置信区间[95％CI]：1.38-3.44；P=0.0009）和内陷胰腺的包裹（OR：0.37，95％CI：0.17-0.84；P=0.01）是PG出血的独立危险因素。
结论：在大音量设置中，约5％的患者发生内陷PG引起的吻合口出血，并伴有胰腺实质和小wirsung导管。通过包裹内陷的胰腺残端观察到的PG出血率降低，值得在前瞻性随机研究中进一步评估。
方法：我们回顾性评估了2011年4月1日至2022年12月31日之间使用双荷包技术内陷PG进行的所有连续PD。多因素分析确定了吻合口PG出血的危险因素。
结果：在研究期间，695名中位年龄为66岁的连续患者接受了PD;大多数是针对导管胰腺腺癌进行的。同时行血管切除328例。术后死亡率为4.1%。33例（4.6％）患者发生PG出血，中位间隔为5天（范围，1-14）来自手术，导致21人(63%)再次手术。PG出血相关死亡率为9.0%。多变量分析确定了软胰腺结构和Wirsung导管>3或≤3mm(C类和D类,分别,ISGPS）（比值比[OR]：2.17，95％置信区间[95％CI]：1.38-3.44；P=0.0009）和内陷胰腺的包裹（OR：0.37，95％CI：0.17-0.84；P=0.01）是PG出血的独立危险因素。
结论：在大音量设置中，约5％的患者发生内陷PG引起的吻合口出血，并伴有胰腺实质和小wirsung导管。通过包裹内陷的胰腺残端观察到的PG出血率降低，值得在前瞻性随机研究中进一步评估。
