高级检索
中华肝胆外科杂志
期刊首页
过刊列表
高级检索
稿件发表
• 综述 •
ENGLISH ABSTRACT
术后胰瘘与腹腔感染关系的研究进展
陈飞
姜翀弋
王巍
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1007-8118.2020.03.022
Progress in the relationship between postoperative pancreatic fistula and abdominal infection
Chen Fei
Jiang Chongyi
Wang Wei
Authors Info & Affiliations
Chen Fei
Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai 200040, China
Jiang Chongyi
Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai 200040, China
Wang Wei
Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai 200040, China
·
DOI： 10.3760/cma.j.issn.1007-8118.2020.03.022
0
0
0
0
0
0
PDF下载
APP内阅读
摘要

术后胰瘘是胰腺切除术后危及患者生命的主要并发症，发生率为3%～45%。尽管近几十年来胰腺手术技术取得了显著进步，围手术期死亡率持续下降，但术后胰瘘的发生率仍然很高。胰腺切除术后临床相关的术后胰瘘常伴有腹腔感染，腹腔感染不仅仅与术后胰瘘相关，还可能是术后胰瘘发生发展重要的诱发与加重因素，但两者之间的确切相关性并不清楚。本文主要就目前术后胰瘘与腹腔感染关系的研究进展进行综述。

胰十二指肠切除术;术后胰瘘;感染
ABSTRACT

Postoperative pancreatic fistula (POPF) is one of the main life-threatening complications after pancreatectomy, with an incidence of 3% to 45%. Despite there were significant advances in pancreatic surgery in recent decades and continued decreasing mortality, the incidence of postoperative pancreatic fistula still remains high. Clinically relevant postoperative pancreatic fistula after pancreatic surgery is often accompanied by abdominal infection. Studies have shown that abdominal infection is not only related to postoperative pancreatic fistula, but also it’s an important factor which may induce and aggravate the development of postoperative pancreatic fistula. The exact correlation between POPF and abdominal infection is not clear. The goal of this review is to discuss the current research progress on the relationship between postoperative pancreatic fistula and abdominal infection.

Pancreaticoduodenectomy;Postoperative pancreatic fistula;Infection
Wang Wei, Email: mocdef.6ab21nc3002wgnaw
Copyright by Chinese Medical Association
No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.
All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
引用本文

陈飞,姜翀弋,王巍. 术后胰瘘与腹腔感染关系的研究进展[J]. 中华肝胆外科杂志,2020,26(03)：236-240.

DOI:10.3760/cma.j.issn.1007-8118.2020.03.022

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

术后胰瘘(POPF)是胰腺切除术后常见并发症之一，发生率为3%～45% [ 1 , 2 ]。胰腺分泌的胰液含有多种消化酶，能够帮助人体消化糖类、蛋白质和脂肪，有利于食物吸收。但如果胰液漏至消化道外，并被胆汁或肠液激活，则会导致一系列继发性伤害，如腹腔脓肿、出血、胃排空延迟、脓毒血症等并发症，是患者术后死亡的重要原因。近年来，胰腺切除术后在围手术期死亡率、总体并发症发生率等方面虽然有所改善，但POPF仍是外科医生面临的重大挑战 [ 3 , 4 ]。
根据2017年国际胰腺外科研究小组(ISGPS)对POPF的分级 [ 1 ]，术后≥3 d任意量的引流液中淀粉酶浓度高于正常血清淀粉酶浓度上限3倍以上而无术后进程的明显改变为生化漏(非胰瘘)；B级胰瘘需要改变临床管理或调整临床路径，如持续引流超过3周、临床相关决策改变、经皮肝穿引流/内镜针对性干预和相关出血行血管造影；C级胰瘘需要临床管理的重大变化或偏离正常的临床路径，指的是出现由POPF引起的器官衰竭、二次手术甚至患者死亡。为了预测POPF的发生发展，已有基于危险因素的评分系统评估POPF风险，目前公认与POPF相关的预后因素有胰腺质地柔软、胰管直径细(<5 mm)、术中出血量多(>400 ml)和高危病理类型(除胰腺癌或慢性胰腺炎外的其他疾病)等，其他高危因素还包括术后感染、高体质量指数、术前基础疾病等 [ 5 ]。
胰腺切除术后临床相关的POPF常伴有细菌感染，在大的研究中心，近三分之一接受胰十二指肠切除术(PD)治疗的患者和四分之一远端胰腺切除术(DP)患者发生感染性并发症，导致了更差的临床结果 [ 6 , 7 , 8 ]。相关研究显示，术后腹腔感染是其预后的主要决定因素，合并存在器官/腔隙感染患者有更高的POPF发生率 [ 3 , 9 , 10 ]。本文就POPF与感染关系研究进展进行综述。
试读结束，您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
[1]
Bassi C , Marchegiani G , Dervenis C ,et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after[J]. Surgery, 2017,161(3)：584-591. DOI: 10.1016/j.surg.2016.11.014 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Shubert CR , Wagie AE , Farnell MB ,et al. Clinical risk score to predict pancreatic fistula after pancreatoduodenectomy: independent external validation for open and laparoscopic approaches[J]. J Am Coll Surg, 2015,221(3)：689-698. DOI: 10.1016/j.jamcollsurg.2015.05.011 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Elliott IA , Chan C , Russell TA ,et al. Distinction of risk factors for superficial vs organ-space surgical site infections after pancreatic surgery[J]. JAMA Surg, 2017,152(11)：1023-1029. DOI: 10.1001/jamasurg.2017.2155 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Zhou YM , Zhou X , Wan T ,et al. An evidence-based approach to the surgical interventions for severe pancreatic fistula after pancreatoduodenectomy[J]. Surgeon, 2018,16(2)：119-124. DOI: 10.1016/j.surge.2017.07.005 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Mcmillan MT , Soi S , Asbun HJ ,et al. Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation[J]. Ann Surg, 2016，264(2)：344-352. DOI: 10.1097/sla.0000000000001537 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Santangelo M , Esposito A , Tammaro V ,et al. What indication, morbidity and mortality for central pancreatectomy in oncological surgery? A systematic review[J]. Int J Surg, 2016,28(Suppl 1)：S172-S176. DOI: 10.1016/j.ijsu.2015.12.046 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Milito P , Aiolfi A , Asti E ,et al. Impact of spleen preserving laparoscopic distal pancreatectomy on postoperative infectious complications: systematic review and meta-analysis[J]. J Laparoendosc Adv Surg Tech A, 2019,29(2)：167-177. DOI: 10.1089/lap.2018.0738 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Okano K , Hirao T , Unno M ,et al. Postoperative infectious complications after pancreatic resection[J]. Br J Surg, 2015,102(12)：1551-1560. DOI: 10.1002/bjs.9919 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
De Pastena M , Paiella S , Marchegiani G ,et al. Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: results from a high-volume center[J]. Surgery, 2017,162(4)：792-801. DOI: 10.1016/j.surg.2017.05.016 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Pratt WB , Callery MP , Vollmer CM Jr. The latent presentation of pancreatic fistulas[J]. Br J Surg, 2009,96(6)：641-649. DOI: 10.1002/bjs.6614 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Fu SJ , Shen SL , Li SQ ,et al. Risk factors and outcomes of postoperative pancreatic fistula after p ancreatico-duodenectomy: an audit of 532 consecutive cases [J]. BMC Surg, 2015,15：34. DOI: 10.1186/s12893-015-0011-7 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Loos M , Strobel O , Legominski M ,et al. Postoperative pancreatic fistula: microbial growth determines outcome[J]. Surgery, 2018,164(6)：1185-1190. DOI: 10.1016/j.surg.2018.07.024 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Iso Y , Sawada T , Tagaya N ,et al. Pancreatic juice leakage is a risk factor for deep mycosis after pancreatic surgery[J]. Surg Today, 2009,39(4)：326-331. DOI: 10.1007/s00595-008-3871-y .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Okamura K , Tanaka K , Miura T ,et al. Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction[J]. J Hepatobiliary Pancreat Sci, 2017,24(7)：382-393. DOI: 10.1002/jhbp.453 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Fong ZV , Mcmillan MT , Marchegiani G ,et al. Discordance between perioperative antibiotic prophylaxis and wound infection cultures in patients undergoing pancreaticoduodenectomy[J]. JAMA Surg, 2016,151(5)：432-439. DOI: 10.1001/jamasurg.2015.4510 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Ohgi K , Sugiura T , Yamamoto Y ,et al. Bacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy[J]. Surgery, 2016,160(3)：725-730. DOI: 10.1016/j.surg.2016.03.032 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Herzog T , Belyaev O , Akkuzu R ,et al. The impact of bile duct cultures on surgical site infections in pancreatic surgery[J]. Surg Infect (Larchmt), 2015,16(4)：443-449. DOI: 10.1089/sur.2014.104 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Gavazzi F , Ridolfi C , Capretti G ,et al. Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in surgical site infections after pancreaticoduodenectomy[J]. BMC Gastroenterol, 2016,16：43. DOI: 10.1186/s12876-016-0460-1 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
El Nakeeb A , Salem A , Mahdy Y ,et al. Value of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: a case-control study[J]. Asian J Surg, 2018,41(2)：155-162. DOI: 10.1016/j.asjsur.2016.10.004 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
陈潇远，毛谅，周铁，等. 肝门部胆管癌患者术前经内镜鼻胆管与经皮经肝穿刺引流的效果比较[J]. 中华肝胆外科杂志， 2018,24(12)：812-817. DOI: 10.3760/cma.j.issn.1007-8118.2018.12.006 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Kajiwara T , Sakamoto Y , Morofuji N ,et al. An analysis of risk factors for pancreatic fistula after pancreaticoduodenectomy: clinical impact of bile juice infection on day 1[J]. Langenbecks Arch Surg, 2010,395(6)：707-712. DOI: 10.1007/s00423-009-0547-z .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Tanaka K , Matsuo K , Kawaguchi D ,et al. Randomized clinical trial of peritoneal lavage for preventing surgical site infection in elective liver surgery[J]. J Hepatobiliary Pancreat Sci, 2015,22(6)：446-453. DOI: 10.1002/jhbp.222 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Sugiura T , Mizuno T , Okamura Y ,et al. Impact of bacterial contamination of the abdominal cavity during pancreaticoduodenectomy on surgical-site infection[J]. Br J Surg, 2015,102(12)：1561-1566. DOI: 10.1002/bjs.9899 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Yamashita K , Kato D , Sasaki T ,et al. Contaminated drainage fluid and pancreatic fistula after pancreatoduodenectomy: a retrospective study[J]. Int J Surg, 2018,52：314-319. DOI: 10.1016/j.ijsu.2018.02.057 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Yang F , Jin C , Li J ,et al. Clinical significance of drain fluid culture after pancreaticoduodenectomy[J]. J Hepatobiliary Pancreat Sci, 2018,25(11)：508-517. DOI: 10.1002/jhbp.589 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Nagakawa Y , Matsudo T , Hijikata Y ,et al. Bacterial contamination in ascitic fluid is associated with the development of clinically relevant pancreatic fistula after pancreatoduodenectomy[J]. Pancreas, 2013,42(4)：701-706. DOI: 10.1097/MPA.0b013e31826d3a41 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Morimoto M , Honjo S , Sakamoto T ,et al. Bacterial smear test of drainage fluid after pancreaticoduodenectomy can predict postoperative pancreatic fistula[J]. Pancreatology, 2019，19(2):274-279. DOI: 10.1016/j.pan.2019.01.018 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Bassi C , Molinari E , Malleo G ,et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial[J]. Ann Surg, 2010,252(2)：207-214. DOI: 10.1097/SLA.0b013e3181e61e88 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Kawai M , Tani M , Terasawa H ,et al. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients[J]. Ann Surg, 2006,244(1)：1-7. DOI: 10.1097/01.sla.0000218077.14035.a6 .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Olsen I . Biofilm-specific antibiotic tolerance and resistance[J]. Eur J Clin Microbiol Infect Dis, 2015,34(5)：877-886. DOI: 10.1007/s10096-015-2323-z .
返回引文位置Google Scholar
百度学术
万方数据
[31]
张军峰，孙勇伟，花荣，等. 胰腺术后腹腔感染的分析及治疗[J]. 中华肝胆外科杂志， 2014,20(7)：519-523. DOI: 10.3760/cma.j.issn.1007-8118.2014.07.011
返回引文位置Google Scholar
百度学术
万方数据
[32]
Sato A , Masui T , Nakano K ,et al. Abdominal contamination with Candida albicans after pancreaticoduodenectomy is related to hemorrhage associated with pancreatic fistulas[J]. Pancreatology, 2017,17(3)：484-489. DOI: 10.1016/j.pan.2017.03.007 .
返回引文位置Google Scholar
百度学术
万方数据
[33]
Yamashita K , Sasaki T , Itoh R ,et al. Pancreatic fistulae secondary to trypsinogen activation by Pseudomonas aeruginosa infection after pancreatoduodenectomy[J]. J Hepatobiliary Pancreat Sci, 2015,22(6)：454-462. DOI: 10.1002/jhbp.223 .
返回引文位置Google Scholar
百度学术
万方数据
[34]
Zhang JF , Zhu HY , Sun YW ,et al. Pseudomonas aeruginosa infection after pancreatoduodenectomy: risk factors and clinic impacts[J]. Surg Infect (Larchmt), 2015,16(6)：769-774. DOI: 10.1089/sur.2015.041 .
返回引文位置Google Scholar
百度学术
万方数据
[35]
Bartash R , Nori P . Beta-lactam combination therapy for the treatment of Staphylococcus aureus and Enterococcus species bacteremia: a summary and appraisal of the evidence[J]. Int J Infect Dis, 2017,63：7-12. DOI: 10.1016/j.ijid.2017.07.019 .
返回引文位置Google Scholar
百度学术
万方数据
[36]
Shogan BD , Smith DP , Christley S ,et al. Intestinal anastomotic injury alters spatially defined microbiome composition and function[J]. Microbiome, 2014,2：35. DOI: 10.1186/2049-2618-2-35 .
返回引文位置Google Scholar
百度学术
万方数据
[37]
Shogan BD , Belogortseva N , Luong PM ,et al. Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak[J]. Sci Transl Med, 2015,7(286)：286ra68. DOI: 10.1126/scitranslmed.3010658 .
返回引文位置Google Scholar
百度学术
万方数据
[38]
Belmouhand M , Krohn PS , Svendsen LB ,et al. The occurrence of enterococcus faecium and faecalis is significantly associated with anastomotic leakage after pancreaticoduodenectomy[J]. Scand J Surg, 2018，107(2)：107-113. DOI: 10.1177/1457496917731188 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
王巍，Email： mocdef.6ab21nc3002wgnaw
B
所有作者均声明不存在利益冲突
C
上海市申康专科疾病临床"五新"转化项目 (16CR3107B)
评论 （0条）
注册
登录
时间排序
暂无评论，发表第一条评论抢沙发
最新推荐
更多
剑突下拉钩单孔胸腔镜全胸腺切除术的技术要领——手术流程标准化
徐向南 等
中华胸心血管外科杂志 2023,39(05)
经剑突下与经肋间单孔胸腔镜胸腺切除术倾向性评分匹配对比研究
蔡剑桥 等
中华胸心血管外科杂志 2021,37(11)
剑突下切口胸腔镜全胸腺切除术治疗胸腺肿瘤9例
郭清奎 等
中华胸心血管外科杂志 2020,36(03)
经剑突下单孔胸腔镜肺切除术93例
宋楠 等
中华胸心血管外科杂志 2016,32(03)
MedAI助手（体验版）
文档即答
智问智答
机器翻译
回答内容由人工智能生成，我社无法保证其准确性和完整性，该生成内容不代表我们的态度或观点，仅供参考。
生成快照
文献快照

你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持：

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号
小中大