胰十二指肠切除术后胰肠吻合口愈合的影响因素及防治策略研究进展

Advances in influencing factors and prevention strategies for pancreaticojejunostomy healing after pancreaticoduodenectomy

摘要:

胰十二指肠切除术（PD）后胰瘘（POPF）是影响患者预后的主要并发症，其发生与胰肠吻合口愈合密切相关。本文系统梳理近年来国内外相关研究，从术前评估、术中技术及术后管理三个方面，阐述影响PD术后胰肠吻合口愈合的关键因素及其防治策略。术前方面，胰腺质地柔软、主胰管细小、肥胖及炎症-营养指标异常（如C-反应蛋白/白蛋白比值）是重要风险因素；术中方面，吻合方式的选择应基于胰腺条件个体化决策，新型缝合材料、机器人辅助手术及生物材料（如水凝胶）在降低POPF风险方面展现出潜在优势；术后方面，引流液细菌定植控制、早期引流管移除及血糖管理是影响愈合的重要环节。未来应进一步探索多因素协同机制，构建动态预测模型，并通过高质量临床研究验证新技术与新材料的有效性，以实现POPF的精准化与个体化防治。

Abstract:

Postoperative pancreatic fistula (POPF) remains a major complication affecting prognosis after pancreaticoduodenectomy (PD), closely associated with the healing of pancreaticojejunostomy. This review systematically summarizes recent advances in the key factors influencing anastomotic healing after PD from three aspects: preoperative assessment, intraoperative techniques, and postoperative management. Preoperatively, soft pancreatic texture, small main pancreatic duct, obesity, and inflammatory-nutritional markers (such as the C-reactive protein-to-albumin ratio) are identified as major risk factors. Intraoperatively, the choice of anastomotic technique should be individualized based on pancreatic characteristics, while novel suture materials, robotic assistance, and emerging biomaterials (e.g., hydrogels) show promising potential in reducing POPF risk. Postoperatively, control of bacterial colonization in drainage fluid, early drain removal, and strict glycemic management play critical roles in anastomotic healing. Future studies should focus on elucidating multifactorial synergistic mechanisms, developing dynamic predictive models, and validating new techniques and biomaterials through high-quality clinical trials to achieve precision and individualized management of POPF.