Nakamura Yoshiharu, Matsumoto Satoshi, Matsushita Akira, Yoshioka Masato, Shimizu Tetsuya, Yamahatsu Kazuya, Uchida Eiji
Department of Surgery, Nippon Medical School, Tokyo, Japan.
Asian J Endosc Surg. 2012 Nov;5(4):191-4. doi: 10.1111/j.1758-5910.2012.00145.x.
We introduce a technique for pancreaticojejunostomy with closure of the pancreatic stump by endoscopic linear stapler as a reliable intervention with benefits for pancreatic resection in laparoscopic pancreaticoduodenectomy (Lap-PD).
Following laparoscopic resection, we perform pancreaticojejunostomy under direct visualization. We employ the same method as in open surgery and enter via a 4-5-cm incision, the minimum size feasible for easy removal of resected material from the body, positioned directly above the stump of the distal pancreas. In January 2011, we began using endoscopic linear stapler when cutting the pancreas during Lap-PD in order to reduce the leakage of pancreatic juice, which may contain tumor cells from the neoplastic lesion. Since then, we have used this procedure in 12 subjects undergoing Lap-PD and 5 subjects undergoing laparoscopic central pancreatectomy. We have observed postoperative complication in only one of the laparoscopic central pancreatectomy cases, involving grade B/C pancreatic fistula, and in none of the Lap-PD cases.
Our pancreaticojejunostomy with closure of the pancreatic stump by endoscopic linear stapler is a feasible procedure in Lap-PD and has produced positive results over a short time frame.
我们介绍一种在腹腔镜胰十二指肠切除术（Lap-PD）中，使用内镜直线切割吻合器闭合胰腺残端进行胰肠吻合的技术，这是一种可靠的干预措施，对胰腺切除有益。
腹腔镜切除术后，我们在直视下进行胰肠吻合。我们采用与开放手术相同的方法，通过一个4-5厘米的切口进入，该切口为能轻松从体内取出切除组织的最小可行尺寸，位于胰腺远端残端正上方。2011年1月，我们开始在Lap-PD手术中切割胰腺时使用内镜直线切割吻合器，以减少可能含有肿瘤病变肿瘤细胞的胰液渗漏。从那时起，我们已在12例行Lap-PD手术的患者和5例行腹腔镜全胰切除术的患者中应用了该手术方法。我们仅在1例腹腔镜全胰切除术患者中观察到术后并发症，为B/C级胰瘘，而在Lap-PD手术患者中均未观察到并发症。
我们使用内镜直线切割吻合器闭合胰腺残端的胰肠吻合术在Lap-PD手术中是可行的，并且在短时间内取得了积极的效果。
