Kakinoki K, Okano K, Oshima M, Suto H, Kashiwagi H, Yamamoto N, Akamoto S, Fujiwara M, Yachida S, Takama T, Hagiike M, Usuki H, Kamata H, Masaki T, Suzuki Y
Hepatogastroenterology. 2014 Mar-Apr;61(130):469-74.
BACKGROUND/AIMS: Soft pancreases are susceptible to developing pancreatic fistula following pancreaticoduodenectomy. To reduce the incidence of pancreatic fistula after pancreaticoduodenectomy in patients with a soft pancreas, we developed a triple secured technique. In this study, we describe the details of this technique and also report on the postoperative outcomes.
The triple secured technique employed an ultrasonic dissector for pancreatic transection with skeletonizing and ligating of the small pancreatic branch ducts, duct-invagination or duct-to-mucosa anastomosis for main pancreatic duct management, and, finally, four large stitches between the pancreatic stump parenchyma and the jejunal seromuscular layer to prevent minor pancreatic leakage. A total of 28 consecutive patients with a soft pancreas who underwent pancreaticoduodenectomy using our technique were included in this study.
Postopetrative complications occurred in 16 patients. Grade B pancreatic fistula developed in 6 patients. However, no grade C pancreatic fistula occurred in this series. Neither any reoperation nor in-hospital mortality was observed in this series.
Our triple secured technique after pancreaticoduodenectomy was feasible and safe, with an acceptable rate of grade B pancreatic fistula and no grade C pancreatic fistula for patients with a soft pancreas.
背景/目的：质地柔软的胰腺在胰十二指肠切除术后易发生胰瘘。为降低质地柔软的胰腺患者胰十二指肠切除术后胰瘘的发生率，我们开发了一种三重加固技术。在本研究中，我们描述了该技术的细节，并报告术后结果。
三重加固技术采用超声刀进行胰腺横断，同时对胰腺小分支导管进行骨骼化处理并结扎，采用导管内翻或导管-黏膜吻合术处理主胰管，最后在胰腺残端实质与空肠浆肌层之间缝合4针以防止胰液少量渗漏。本研究共纳入28例连续接受使用我们技术的胰十二指肠切除术的质地柔软的胰腺患者。
16例患者发生术后并发症。6例患者发生B级胰瘘。然而，本系列中未发生C级胰瘘。本系列中未观察到再次手术或住院死亡情况。
我们的胰十二指肠切除术后三重加固技术可行且安全，对于质地柔软的胰腺患者，B级胰瘘发生率可接受，且无C级胰瘘发生。
