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Background : Pancreatic fistula is major source of postoperative morbidity or mortality. Soft pancreas has been considered to be one of the most important risk factors for pancreatic fistula. The purp...ose of the study is to clarify the relationship among extravasation of pancreatic secretions from the pancreatic stump, the pancreatic texture and clinical pancreatic fistula after pancreaticoduodenectomy. Methods : For nineteen patients who were treated between July 2007 and August 2008, we performed intraoperative pancreatic leakage test to confirm the extravasation of pancreatic secretions from the pancreatic stump. Degree of fibrosis at the cut surface of the pancreas was reviewed blindly. Results : Serum pancreatic amylase increased on first postoperative day (POD) and returned to preoperative level on 3POD. These change were inversely correlated with fibrosis (P < 0.001), namely the amylase level in patients with normal to mild fibrotic pancreas showed marked increase on 1POD, but not in those with moderate to severe fibrotic pancreas. Positive pancreatic leakage test was recognized in five patients (26.3%), four of 9 patients with soft pancreas (44.4%) and one of 10 with hard pancreas (10.0%). In soft pancreas, all four cases showing positive leakage test developed pancreatic fistula after pancreaticoduodenectomy, while one positive case in hard pancreas did not develop pancreatic fistula. Conclusion : The extravasation of pancreatic secretions from the pancreatic stump occurred frequently in soft pancreas, which might result in postoperative pancreatic fistula. Therefore we should take care in treating branched duct as well as main pancreatic duct at the pancreatic stump of soft pancreas.
【はじめに】膵液漏は膵切除術合併症で特に問題となる合併症である．Soft pancreasは膵液漏の危険因子と言われている．今回膵切離断端からの膵液の漏れと，膵の繊維化の程度，膵液漏の発生との関連性を明らかにした．【方法】膵頭十二指腸切除を行った19症例に対して，切除端の膵管からアトムチューブを挿入しインジコカルミン溶液を注入し断端からの色素の漏れの有無を調べ，切除膵の繊維化の程度と組織学的になし，軽度，中等度，高度に郡別し比較．【結果】血清アミラーゼ値は，術後1日目に上昇し，3 日目には術前値に戻っていたが，1 日目の上昇は繊維化がないほど有意に高値を示した．リークテスト陽性を5例に認めたが，1例をのぞきsoft pancreas症例であった．リークテスト陽性であったsoft pancreas症例4例は全例膵液漏を生じたが，リークテスト陽性であったhard pancreas症例は膵液漏を生じなかった．【まとめ】Soft pancreasにおいては膵断端の分枝膵管からの漏れも多く，膵液漏の原因である可能性があり分枝膵管にも注意を払うべきと考えられる．続きを見る
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