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大样本研究中心中胰十二指肠切除术的死亡率低于5%。 然而并发症发生率在30%-60%， 主要的并发症和死亡原因之一就是术后残存胰腺发生的胰漏，药理学方面和技术上尝试控制胰漏的发生， 但仅有部分治疗方法如生长抑素及类似物，特别是奥曲肽对预防并发症（胰漏和腹腔积液）有效。[116]Kocher HM, Alrawashdeh W. Pancreatic cancer. BMJ Clin Evid. 2010 May 19;2010.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907593/http://www.ncbi.nlm.nih.gov/pubmed/21729338?tool=bestpractice.com[117]Gurusamy KS, Koti R, Fusai G, et al. Somatostatin analogues for pancreatic surgery. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD008370.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008370.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23633353?tool=bestpractice.com [  ]In patients undergoing pancreatic surgery, what are the benefits and harms of post-operative administration of somatostatin analogues?https://cochranelibrary.com/cca/doi/10.1002/cca.607/full显示答案 当断端吻合之后不推荐将胰腺导管阻塞来预防胰漏，因为有报道称有可能会引起胰瘘和胰腺内分泌和外分泌障碍。[116]Kocher HM, Alrawashdeh W. Pancreatic cancer. BMJ Clin Evid. 2010 May 19;2010.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907593/http://www.ncbi.nlm.nih.gov/pubmed/21729338?tool=bestpractice.com 虽然一些研究表明胰胃吻合术比胰空肠吻合术更可能减少术后胰瘘的发生率，[118]Figueras J, Sabater L, Planellas P, et al. Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br J Surg. 2013 Nov;100(12):1597-605.http://www.ncbi.nlm.nih.gov/pubmed/24264781?tool=bestpractice.com[119]Topal B, Fieuws S, Aerts R, et al; Belgian Section of Hepatobiliary and Pancreatic Surgery. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol. 2013 Jun;14(7):655-62.http://www.ncbi.nlm.nih.gov/pubmed/23643139?tool=bestpractice.com [ ]After pancreaticoduodenectomy, how does anastomosis between the pancreatic stump and the jejunum compare with anastomosis between the pancreatic stump and the stomach?https://cochranelibrary.com/cca/doi/10.1002/cca.1970/full显示答案但证据缺乏，一些研究报道的结果存在冲突，并且有偏倚高风险。[116]Kocher HM, Alrawashdeh W. Pancreatic cancer. BMJ Clin Evid. 2010 May 19;2010.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907593/http://www.ncbi.nlm.nih.gov/pubmed/21729338?tool=bestpractice.com[120]Wente MN, Shrikhande SV, Muller MW, et al. Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg. 2007 Feb;193(2):171-83.http://www.ncbi.nlm.nih.gov/pubmed/17236843?tool=bestpractice.com 将胰空肠吻合术与胆汁引流隔离的双环（鲁氏 Y 形）重建显著延长了手术时间，且未能降低术后并发症发生率，因此并不优于传统的单环重建。[121]Klaiber U, Probst P, Knebel P, et al. Meta-analysis of complication rates for single-loop versus dual-loop (Roux-en-Y) with isolated pancreaticojejunostomy reconstruction after pancreaticoduodenectomy. Br J Surg. 2015 Mar;102(4):331-40.http://www.ncbi.nlm.nih.gov/pubmed/25644428?tool=bestpractice.com 没有证据表明使用纤维胶可以预防胰漏。[116]Kocher HM, Alrawashdeh W. Pancreatic cancer. BMJ Clin Evid. 2010 May 19;2010.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907593/http://www.ncbi.nlm.nih.gov/pubmed/21729338?tool=bestpractice.com[120]Wente MN, Shrikhande SV, Muller MW, et al. Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg. 2007 Feb;193(2):171-83.http://www.ncbi.nlm.nih.gov/pubmed/17236843?tool=bestpractice.com [ ]What are the benefits and harms of fibrin sealants for preventing postoperative pancreatic fistula following pancreatic surgery?https://www.cochranelibrary.com/cca/doi/10.1002/cca.2234/full显示答案
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