探讨奥曲肽预防胰十二指肠切除（PD）术后胰瘘的疗效。

回顾性分析2017年1月至2020年1月在中山大学附属第三医院行PD的134例患者临床资料。患者均签置知情同意书，符合医学伦理学规定。其中男83例，女51例；平均年龄（57±11）岁。将胰管直径<3 mm、胰腺质地软作为术后胰瘘发生高风险因素，将患者分为低风险组（64例）和高风险组（70例）；每组再根据是否应用奥曲肽分为奥曲肽组和非奥曲肽组。观察各组患者术后胰瘘发生率，比较采用χ²检验或Fisher确切概率法。

本组患者胰瘘发生率19%（25/134）。低风险组术后胰瘘发生率为11%（7/64），明显低于高风险组26%（18/70） （χ²=4.810，P<0.05）。高风险-奥曲肽组患者术后胰瘘发生率为11%（4/35），明显低于高风险-非奥曲肽组的40%（14/35） （χ²=7.479，P<0.05）。低风险-奥曲肽组和低风险-非奥曲肽组患者术后胰瘘发生率分别为9% （3/32）、13%（4/32）,差异无统计学意义（P=1.000）。

根据患者胰腺组织情况评估PD术后胰瘘风险，奥曲肽能降低高风险患者胰瘘发生风险，而对于低风险患者则无影响。

To evaluate the clinical efficacy of octreotide in preventing pancreatic fistula after pancreaticoduodenectomy (PD).

Clinical data of 134 patients undergoing PD in the Third Affiliated Hospital of Sun Yat-sen University from January 2017 to January 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 83 patients were male and 51 female, aged (57±11) years on average. The diameter of pancreatic duct <3 mm and soft texture of pancreas were regarded as high-risk factors for the postoperative pancreatic fistula, by which patients were divided into low-risk (n=64) and high-risk groups (n=70). In each group, patients were further divided into the octreotide and non-octreotide subgroups according to whether octreotide was used. The incidence of postoperative pancreatic fistula was observed and compared by Chi-square test or Fisher's exact test.

The incidence of pancreatic fistula was 19%(25/134). The incidence of pancreatic fistula in the low-risk group was 11%(7/64), significantly lower than 26%(18/70) in the high-risk group (χ2=4.810, P<0.05). The incidence of pancreatic fistula in the high-risk, octreotide subgroup was 11%(4/35), significantly lower than 40%(14/35) in the high-risk, non-octreotide subgroup (χ2=7.479, P<0.05). The incidence of postoperative pancreatic fistula in the low-risk, octreotide subgroup and low-risk non-octreotide subgroup was 9%(3/32) and 13%(4/32), respectively, where no significant difference was observed (P=1.000).

The risk of pancreatic fistula after PD can be evaluated according to the pancreatic tissues. Octreotide can reduce the risk of pancreatic fistula in high-risk patients, whereas it exerts no effect upon low-risk patients.