胰十二指肠切除术后的 A 型胰空肠吻合术支架:一定有必要吗?

Dimitrios Symeonidis, Dimitris Zacharoulis, Georgios Tzovaras, Labrini Kissa, Athina A Samara, Eleana Petsa, Konstantinos Tepetes
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引用次数: 0

摘要

术后胰瘘(POPF)是胰十二指肠切除术(PD)最常见也是最严重的并发症。因此,有必要对手术技术或药物干预进行技术改造,以降低这种经常造成严重后果的并发症的发生率。在这一方向上,使用内部或外部支架对胰管进行支架植入的方法得到了评估。从理论上讲,这种方法可以消除导致 POPF 发生的许多病理生理因素。本研究的目的是通过使用 PubMed 和参考文献引用分析,回顾有关胰管支架置入术对 POPF 发生率的作用的现有数据。总体而言,之前的研究似乎强调了外置支架在 POPF 发生率方面优于内置支架;但这是以主要与支架移除相关的发病率增加为代价的。当然,使用内支架是一种创伤较小的方法,效果可以接受,而且肯定不会出现胰液从胃肠道完全转移的弊端。考虑到这方面的高质量数据稀缺,将支架置入术保留给高风险的 POPF 患者,并根据每个病例的不同特点个性化选择使用内支架或外支架的方法似乎是合适的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Stent A pancreaticojejunostomy after pancreatoduodenectomy: Is it always necessary?

The establishment of a postoperative pancreatic fistula (POPF) is considered the most common and, concomitantly, the most serious complication associated with pancreaticoduodenectomy (PD). The search for either technical modifications of the operative technique or pharmaceutical interventions that could possibly aid in decreasing the incidence of this often-devastating complication appears justified. The stenting of the pancreatic duct, with the use of either internal or external stents, has been evaluated in this direction. In theory, it is an approach that could eliminate many pathophysiological factors responsible for the occurrence of a POPF. The purpose of the present study was to review the current data regarding the role of pancreatic duct stenting on the incidence of POPF, after PD, by using PubMed and Reference Citation Analysis. In general, previous studies seem to highlight the superiority of external stents over their internal counterparts in regard to the incidence of POPF; this is at the cost, however, of increased morbidity associated mainly with the stent removal. Certainly, the use of an internal stent is a less invasive approach with acceptable results and is definitely deprived of the drawbacks arising through the complete diversion of pancreatic juice from the gastrointestinal tract. Bearing in mind the scarcity of high-quality data on the subject, an approach of reserving stent placement for the high-risk for POPF patients and individualizing the selection between the use of an internal or an external stent according to the distinct characteristics of each individual case scenario appears appropriate.

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