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| 篇名 |
The Use of Octreotide in the Treatment of Pancreatic Cutaneous Fistula |
| 作者 |
Cheng-Hsi Su, Yi-Ming Shyr, Che-Chuan Loong, Tarng-Jenn Yu, Jer-Kan Wu, Ming Liu, Chen-Hsen Lee, Wing-Yiu Lui |
| 卷期/出版年月 |
28卷6期 (1995/12) |
| 頁次 |
468-476 |
| 摘要 |
During the past three years, nine patients with external pancreatic fistula
and three patients with pancreaticojejunostomy leakage were treated with octreotide and total parenteral nutrition. The fistulas developed after drainage of a pancreatic pseudocyst (3), distal pancreatectomy for pancreatic tumor (2), blunt abdominal injury (2), splenectomy for autoimmune hemolytic anemia (1), resection of stomach tumor (1) and following Whipple operation (3), respectively. Of the patients with external pancreatic fistula, two had high-output (>200 ml/day), and seven had low-output fistulas (<200 ml/day). Fistula output decreased from 117±19 ml/day to 95±47 ml/day (mean± S. E. M.) on the first day of therapy with three daily doses of 0.1 mg octreotide subcutaneously, then to 33± 10 ml/day (p<0.05）on the seventh day of therapy. The octreotide was given over a mean of 23 days (range 12 to 50 days). Three patients had prompt closure of the fistula within eight days of treatment; however one of them developed subsequent pancreatic pseudocyst eight months later, necessitating further drainage because of downstream obstruction. Finally a pancreaticojejunostomy was necessary to solve this problem. The other five patients had persistent fistulous drainage for a mean of 60 days; the fistulas closed eventually. One patient had a permanant fistula following drainage for a pancreatic pseudocyst, and a ductal stricture at the pancreatic body was demonstrated. Those three patients with pancreaticojejunostomy leakage following Whipple operation were treated conservatively, and their fistulas closed at 筍， 31 and 32 days following treatment. It is well demonstrated that octreotide is a good adjunct in the management of external pancreatic fistula. However appropriate control of fistulous tract infection and imaging study of the ductal anatomy are essential for further management. It is emphasized that surgery is indicated to correct the anatomical problem; otherwise a fistula remains open and will not heal with just a pharmacologic approach. |
| 關鍵詞 |
octreotide (SMS 201-995), pancreatic cutaneous fistula |
| 分類 |
Original Article |
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