Post-operative pancreatic fistula (POPF) is a serious yet far too common complication following distal pancreatectomy (DP), as it affects 20–30% of patients after DP. POPF raises the risk of other complications and causes delays to a patient’s oncologic care. In this review, we present the latest data on patient risk factors for developing POPF, such as obesity, smoking, young age, thick pancreas, lack of epidural anesthesia, hypoalbuminemia, and elevated drain amylase levels. Other risk factors that have been identified with irregular consistency include open surgical approach, non-malignant or neuroendocrine tumor pathology, simultaneous splenectomy, simultaneous vascular resection, and long operative time. We also review the consequences of POPF, which include hemorrhage, infection, delayed gastric emptying, re-operation, re-admission, delays in adjuvant chemotherapy initiation, reduced progression-free survival, and reduced overall survival. Finally, we present strategies that have been studied for avoiding POPF after DP, including reducing pressure at the sphincter of Oddi, the use of sealants and patches, optimizing pancreatic transection, strategies for post-operative drain placement, the use of post-operative somatostatin analogues, and pre-clinical studies of experimental devices and techniques that may inform future trials. This review informs readers on the current state of the art with regard to POPF after DP and sets the stage for future studies to improve patient outcomes.
术后胰瘘是远端胰腺切除术后一种严重且极为常见的并发症，其发生率可达20%-30%。该并发症不仅会增加其他并发症风险，还会延误患者的肿瘤治疗进程。本文综述了当前关于术后胰瘘患者危险因素的最新数据，包括肥胖、吸烟、年轻、胰腺组织肥厚、未采用硬膜外麻醉、低白蛋白血症及引流液淀粉酶水平升高等。其他已识别但证据一致性不足的危险因素包括：开放手术入路、非恶性或神经内分泌肿瘤病理类型、同期脾切除术、同期血管切除以及手术时间过长。本文同时探讨了术后胰瘘引发的临床后果，涵盖出血、感染、胃排空延迟、再次手术、再入院、辅助化疗启动延迟、无进展生存期缩短及总生存期降低等方面。最后，本文系统评述了预防远端胰腺切除术后胰瘘的研究策略，包括降低Oddi括约肌压力、使用封闭剂与补片、优化胰腺离断技术、术后引流管放置策略、术后生长抑素类似物应用，以及可能为未来临床试验提供依据的实验性装置与技术的临床前研究。本综述旨在为读者呈现远端胰腺切除术后胰瘘防治领域的最新进展，并为改善患者预后的后续研究奠定基础。
肿瘤(癌症)患者之家