应用奥曲肽预防胰十二指肠切除术后胰漏作用的研究

目的：预防性使用奥曲肽是否能减少胰十二指肠切除术后胰漏发生率存在着争议。本研究旨在研究奥曲肽在不同胰腺情况下预防胰十二指肠切除术后胰漏发生的作用。方法：本研究将＂软胰腺＂、＂细胰管＂作为术后胰漏发生的高危险因素,将184例胰十二指肠切除术病例分为4组：低危险/非奥曲肽组、低危险/奥曲肽组、高危险/非奥曲肽组、高危险/奥曲肽组。观察术后胰漏等术后并发症情况。结果：共发生术后胰漏35例（19%）,其中高危险组胰漏发生率是低危险组2倍以上（27%versus 10%,P〈0.01）。在胰漏发生低危险胰腺情况下,奥曲肽组与非奥曲肽组术后胰漏发生无显著差别;在胰漏发生高危险胰腺情况下,奥曲肽能显著降低术后胰漏发生率。结论：在胰十二指肠切除术围手术期应根据胰腺的具体情况选择性使用奥曲肽既能有效预防术后胰漏的发生,又能避免不必要的浪费。

Application of Octreotide in Prevention of Pancreatic Leakage after Pancreaticoduodenectomy

Objective：Octreotide has been studied in multiple trials and is thought to prevent postoperative pancreatic fistula（POPF） formation after pancreatic surgery,however,results are controversial.The aim of this study was to evaluate the impact of prophylactic octreotide on POPF in patients with different pancreatic scenarios undergoing pancreaticoduodenectomy.Methods：The high-risk glands for POPF were defined as those with soft gland texture and small pancreatic duct size.One hundred eighty-four consecutive patients with pancreaticoduodenectomy were stratified into 4 groups：low risk/no octreotide group（n=43）,low risk/octreotide group（n=43）,high risk/no octreotide group（n=49） and high risk/ octreotide group（n=49）.In octreotide groups,prophylactic octreotide was administered intraoperatively and continued postoperatively.Outcomes,including complications and survival rates,are reported.Results：Overall,POPF were present in 19% of all patients.The incidence of POPF was twice as high among patients with high-risk glands compared with those with low-risk glands.Prophylactic octreotide in low-risk glands was not effective after PD.But in patients with high-risk glands,octreotide prophylaxis was associated with a decreased incidence of POPF（14% versus 39%）.Conclusion：Soft pancreatic parenchyma and small pancreatic duct size（≤3 mm） were correlated with incidence and severity of POPF and octreotide should be administered selectively to patients with high-risk glands.