膵切除各術式における膵液瘻発生頻度

膵切除術後合併症のうち，膵液瘻（以下，PF）に関する最新の報告を横断的に検討した。膵頭十二指腸切除術後のPFでは，膵胃吻合が膵空腸吻合より良好な術後成績と報告され，陥入法と膵管空腸粘膜吻合法との比較では術後成績は同等であった。膵管ステントの留置は，PFの減少に有用であったが，内瘻と外瘻に関する成績は同等であった。尾側膵切除術では，PFの予防に膵断端の処理法が重要となる。現在広く行われている自動縫合器による膵断端の処理は汎用性の高い方法ではあるが，他の方法を大きく凌駕する成績までは得られていない。メッシュによる断端の補強は臨床上問題となるISGPF Grade B/CのPFの発生を低下させ，有用...

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Published in日本外科感染症学会雑誌 Vol. 15; no. 1; pp. 85 - 93
Main Authors 及能, 拓朗, 水口, 徹, 今村, 将史, 永山, 稔, 山口, 洋志, 木村, 康利, 竹政, 伊知朗
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本外科感染症学会 28.02.2018
Japan Society for Surgical Infection
Subjects
尾側膵切除術
膵頭十二指腸切除術
術後膵液瘻
Online AccessGet full text
ISSN1349-5755
2434-0103
DOI10.24679/gekakansen.15.1_85

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Abstract 膵切除術後合併症のうち，膵液瘻（以下，PF）に関する最新の報告を横断的に検討した。膵頭十二指腸切除術後のPFでは，膵胃吻合が膵空腸吻合より良好な術後成績と報告され，陥入法と膵管空腸粘膜吻合法との比較では術後成績は同等であった。膵管ステントの留置は，PFの減少に有用であったが，内瘻と外瘻に関する成績は同等であった。尾側膵切除術では，PFの予防に膵断端の処理法が重要となる。現在広く行われている自動縫合器による膵断端の処理は汎用性の高い方法ではあるが，他の方法を大きく凌駕する成績までは得られていない。メッシュによる断端の補強は臨床上問題となるISGPF Grade B/CのPFの発生を低下させ，有用性が示唆された。膵切除術においてPFを予防する方法は依然として未解決事項であるが，PFの完全克服にむけて今後もさまざまな知見が得られることを期待したい。
AbstractList 膵切除術後合併症のうち，膵液瘻（以下，PF）に関する最新の報告を横断的に検討した。膵頭十二指腸切除術後のPFでは，膵胃吻合が膵空腸吻合より良好な術後成績と報告され，陥入法と膵管空腸粘膜吻合法との比較では術後成績は同等であった。膵管ステントの留置は，PFの減少に有用であったが，内瘻と外瘻に関する成績は同等であった。尾側膵切除術では，PFの予防に膵断端の処理法が重要となる。現在広く行われている自動縫合器による膵断端の処理は汎用性の高い方法ではあるが，他の方法を大きく凌駕する成績までは得られていない。メッシュによる断端の補強は臨床上問題となるISGPF Grade B/CのPFの発生を低下させ，有用性が示唆された。膵切除術においてPFを予防する方法は依然として未解決事項であるが，PFの完全克服にむけて今後もさまざまな知見が得られることを期待したい。
Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgery, such as pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) . In order to evaluate the operative procedures or techniques to prevent POPF after PD or DP, we summarized some randomized controlled trials (RCTs) and meta-analyses of them. Regarding reconstructive procedures in PD, pancreaticogastrostomy was reported safer than pan-creaticojejunostomy. In addition, it was found that pancreatic duct stents tended to reduce POPF after PD compared to non-stent, and there was no significant difference between internal and external stents about the incidence of POPF. In DP, the surgical techniques to transect pancreatic parenchyma are particularly important to prevent POPF. Staple closure has been widely used method in DP, but there were not sufficient evidences that it reduced the rate of POPF compared to other procedures. The reinforcement of pancreatic remnant with mesh was associated with a significant reduced the rate of clinically relevant POPF. In conclusion, the consensus on the best way to prevent POPF after PD or DP remains controversial, so we expect that the further trials will find out them in future. 膵切除術後合併症のうち，膵液瘻（以下，PF）に関する最新の報告を横断的に検討した。膵頭十二指腸切除術後のPFでは，膵胃吻合が膵空腸吻合より良好な術後成績と報告され，陥入法と膵管空腸粘膜吻合法との比較では術後成績は同等であった。膵管ステントの留置は，PFの減少に有用であったが，内瘻と外瘻に関する成績は同等であった。尾側膵切除術では，PFの予防に膵断端の処理法が重要となる。現在広く行われている自動縫合器による膵断端の処理は汎用性の高い方法ではあるが，他の方法を大きく凌駕する成績までは得られていない。メッシュによる断端の補強は臨床上問題となるISGPF Grade B/CのPFの発生を低下させ，有用性が示唆された。膵切除術においてPFを予防する方法は依然として未解決事項であるが，PFの完全克服にむけて今後もさまざまな知見が得られることを期待したい。
Author 永山, 稔
竹政, 伊知朗
及能, 拓朗
今村, 将史
木村, 康利
水口, 徹
山口, 洋志
Author_FL Nagayama Minoru
Imamura Masafumi
Mizuguchi Toru
Kimura Yasutoshi
Yamaguchi Hiroshi
Kyuno Takuro
Takemasa Ichiro
Author_FL_xml – sequence: 1
  fullname: Kyuno Takuro
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  fullname: Kimura Yasutoshi
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  fullname: Imamura Masafumi
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  fullname: Nagayama Minoru
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  fullname: Yamaguchi Hiroshi
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  fullname: Mizuguchi Toru
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  fullname: Takemasa Ichiro
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  fullname: 及能, 拓朗
  organization: 札幌医科大学医学部消化器・総合，乳腺・内分泌外科学講座
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  fullname: 水口, 徹
  organization: 札幌医科大学医学部消化器・総合，乳腺・内分泌外科学講座
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  fullname: 今村, 将史
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  fullname: 永山, 稔
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  fullname: 山口, 洋志
  organization: 札幌医科大学医学部消化器・総合，乳腺・内分泌外科学講座
– sequence: 1
  fullname: 木村, 康利
  organization: 札幌医科大学医学部消化器・総合，乳腺・内分泌外科学講座
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  fullname: 竹政, 伊知朗
  organization: 札幌医科大学医学部消化器・総合，乳腺・内分泌外科学講座
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1) 谷合信彦，川野陽一，高橋　翼，ほか：消化器外科領域における消化管・腹腔内動脈出血に対するIVR．日腹部救急医会誌2005；25：815-820
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References_xml – reference: 49) 木村康利，竹政伊知朗：第 5章　手術　最新トピックス：膵体尾部切除術の断端処理．藤井　努，川井　学編，新世代の膵癌診療・治療バイブル．大阪，メディカ出版，2017；221-226
– reference: 10) Topal B, Fieuws S, Aerts R, et al: Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol 2013; 14: 655-662
– reference: 1) 谷合信彦，川野陽一，高橋　翼，ほか：消化器外科領域における消化管・腹腔内動脈出血に対するIVR．日腹部救急医会誌2005；25：815-820
– reference: 31) Hong S, Wang H, Yang S, et al: External stent versus no stent for pancreaticojejunostomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg 2013; 17: 1516-1525
– reference: 5) Pedrazzoli S :Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF): A systematic review and analysis of the POPF-related mortality rate in 60,739 patients retrieved from the English literature published between 1990 and 2015. Medicine（Baltimore）2017; 96: e6858
– reference: 24) Halloran CM, Platt K, Gerard A, et al: PANasta Trial; Cattell Warren versus Blumgart techniques of panreatico-jejunostomy following pancreato-duodenectomy: Study protocol for a randomized controlled trial. Trials 2016; 17: 30. doi: 10.1186/ s13063-015-1144-9
– reference: 30) Zhou Y, Zhou Q, Li Z, et al: Internal pancreatic duct stent does not decrease pancreatic fistula rate after pancreatic resection: a meta-analysis. Am J Surg 2013; 205: 718-725
– reference: 34) Kamoda Y, Fujino Y, Matsumoto I, et al: Usefulness of performing a pancreaticojejunostomy with an internal stent after a pancreatoduodenectomy. Surg Today 2008; 38: 524-528
– reference: 36) Jang JY, Chang YR, Kim SW, et al: Randomized multicentre trial comparing external and internal pancreatic stenting during pancreaticoduodenecto-my. Br J Surg 2016; 103: 668-675
– reference: 18) Blumgart LH, Fong Y: Surgery of the liver and biliary tract. 3rd ed. New York: Saunders, 2000; 1639-1715
– reference: 50) Nakamura M, Ueda J, Kohno H, et al: Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pan-createctomy. Surg Endosc 2011; 25: 867-871
– reference: 33) Markar SR, Vyas S, Karthikesalingam A, et al: The impact of pancreatic duct drainage following pancreaticojejunostomy on clinical outcome. J Gas-trointest Surg 2012; 16: 1610-1617
– reference: 2) Pedrazzoli S, Liessi G, Pasquali C, et al: Postoperative pancreatic fistulas: preventing severe complications and reducing reoperation and mortality rate. Ann Surg 2009; 249: 97-104
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Snippet 膵切除術後合併症のうち，膵液瘻（以下，PF）に関する最新の報告を横断的に検討した。膵頭十二指腸切除術後のPFでは，膵胃吻合が膵空腸吻合より良好な術後成績と報告され，...
Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgery, such as pancreaticoduodenectomy (PD) and distal...
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SubjectTerms 尾側膵切除術
膵頭十二指腸切除術
術後膵液瘻
Title 膵切除各術式における膵液瘻発生頻度
URI https://www.jstage.jst.go.jp/article/gekakansen/15/1/15_85/_article/-char/ja
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Volume 15
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