Gang Wang1, Bei Sun2, Hongchi Jiang1, Le Li1, Yuan Ma1, Linfeng Wu1, Jie Liu1, Panquan Li1, Xiangsong Wu1. 1. Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China. 2. Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China. Email: sunbei70@tom.com.
Abstract
OBJECTIVE: To investigate the effect of pancreatic duct stent internal versus external drainage with pancreaticojejunostomy on the early curative effect after pancreaticoduodenectomy (PD). METHODS: The study was a prospective controlled trial. A total of 219 patients undergoing PD from January 2010 to March 2013 were randomly divided into external drainage group (n = 110) and internal drainage group (n = 109). The pancreatic duct stent was put in the jejunum during the operation in the internal drainage group, while that in the external drainage group was placed outside the body through the jejunum and abdominal wall. The intra-operative blood loss, operative duration, post-operative hospital stay, mortality rate, and the morbidity of pancreatic fistula as well as other complications were compared between the two groups. RESULTS: Compared with internal drainage group, pancreatic duct stent external drainage obviously reduced the morbidity of pancreatic fistula (13.6% vs. 22.6%), delayed gastric emptying (10.0% vs. 27.5%), abdominal infection (6.4% vs. 19.3%), intestinal obstruction (8.2% vs. 20.2%) along with the overall complications (24.5% vs. 41.3%) after PD (χ(2) = 5.735 8 to 11.047 7, P < 0.05), and shortened the healing duration of pancreatic fistula ((11.5 ± 2.9) d vs. (20.1 ± 5.7) d, t = 5.07, P < 0.01), while there was no significant difference in the intra-operative blood loss, operative duration, post-operative hospital stay and mortality rate, etc between the two groups (P > 0.05). CONCLUSIONS:Pancreatic duct stent external drainage can effectively reduce the morbidity of pancreatic fistula and the overall complications after PD, which is safe and feasible. The method is worthy of popularization and application clinically.
RCT Entities:
OBJECTIVE: To investigate the effect of pancreatic duct stent internal versus external drainage with pancreaticojejunostomy on the early curative effect after pancreaticoduodenectomy (PD). METHODS: The study was a prospective controlled trial. A total of 219 patients undergoing PD from January 2010 to March 2013 were randomly divided into external drainage group (n = 110) and internal drainage group (n = 109). The pancreatic duct stent was put in the jejunum during the operation in the internal drainage group, while that in the external drainage group was placed outside the body through the jejunum and abdominal wall. The intra-operative blood loss, operative duration, post-operative hospital stay, mortality rate, and the morbidity of pancreatic fistula as well as other complications were compared between the two groups. RESULTS: Compared with internal drainage group, pancreatic duct stent external drainage obviously reduced the morbidity of pancreatic fistula (13.6% vs. 22.6%), delayed gastric emptying (10.0% vs. 27.5%), abdominal infection (6.4% vs. 19.3%), intestinal obstruction (8.2% vs. 20.2%) along with the overall complications (24.5% vs. 41.3%) after PD (χ(2) = 5.735 8 to 11.047 7, P < 0.05), and shortened the healing duration of pancreatic fistula ((11.5 ± 2.9) d vs. (20.1 ± 5.7) d, t = 5.07, P < 0.01), while there was no significant difference in the intra-operative blood loss, operative duration, post-operative hospital stay and mortality rate, etc between the two groups (P > 0.05). CONCLUSIONS:Pancreatic duct stent external drainage can effectively reduce the morbidity of pancreatic fistula and the overall complications after PD, which is safe and feasible. The method is worthy of popularization and application clinically.