Do Transanastomotic Pancreatic Ductal Stents After Pancreatic Resections Improve Outcomes?

作者：Shukla Parul J^*; Barreto Savio G; Fingerhut Abe

来源：Pancreas, 2010, 39(5): 561-566.

DOI：10.1097/MPA.0b013e3181c52aab

• pancreas
• resection
• outcomes
• fistula
• anastomosis
• leak

Objectives: Despite strategies aimed at reducing a postoperative pancreatic fistula (POPF) after pancreatectomies, the overall incidence remains unchanged. One such procedure, until now incompletely explored, is transanastomotic pancreatic (TAP) ductal stenting.
Methods: We conducted a systematic search using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1983-2008 to determine if TAP ductal stents provide any benefit and, if so, in which clinical scenarios they can be recommended.
Results: Stents can be internal or external, intraoperative only, or temporary (several days). One randomized trial on internal stents across pancreaticojejunostomy (PJ) suggested a higher POPF rate in the stented group. One nonrandomized study using an internal stent for pancreaticogastrostomy (PG) revealed a 0% POPF rate. Results from studies where external stents were used across PJ/PG reported a lower incidence of POPF. No statistically significant difference was reported in a POPF incidence when internal stents were compared with externalized stents. Available data suggest improved outcomes of pancreatoenteric anastomosis when TAP ductal stent is inserted in small ducts (<= 3 mm).
Conclusions: There is insufficient evidence to support or refute improved outcomes after TAP ductal stent insertion in patients with PJ/PG with small ducts (<= 3 mm) or soft pancreata. More evidence of benefit is needed before use of external stents can be recommended.

• 出版日期2010-7