La Greca Gaetano, Primo Stefano, Sofia Maria, Lombardo Rosario, Puleo Stefano, Russello Domenico, Di Cataldo Antonio
Ann Ital Chir. 2014 Sep-Oct;85(5):490-4.
The Achilles' heel of pancreatic surgery is the management of the pancreatic stump. Leakage from pancreatic anastomosis with subsequent fistula, abscess formation, sepsis, or bleeding is one of the most common causes of morbidity and mortality, and it also contributes significantly to prolonged hospitalization and increased hospital expenses. Many surgical methods have been developed aimed at reducing the incidence of post-operative pancreatic fistula. However, the best technique for pancreatico-enteric reconstruction continues to be disputed. Herein, we describe an interim analysis of 35 consecutive pancreatico-duodenectomies, all with the same standardized technique that combines microsurgical technique for duct-to-mucosa pancreatico-jejunostomy with the routine use of fibrin sealant. The rate of leakage of pancreaticojejunostomy was 5,7% (n=2), all of which were grade A fistulas, treated conservatively. The increased precision of magnification instruments and microsurgical technique for duct to mucosa anastomosis, combined with routine sealing of the pancreatic anastomosis are key factors to efficiently manage the pancreatic stump. The good results obtained and especially the minimal rate of fistula suggests that this technical solution is a safe, feasible and reliable approach for pancreatic reconstruction after pancreatico-duodenectomy.
胰腺手术的致命弱点在于胰腺残端的处理。胰肠吻合口漏伴随后续的瘘、脓肿形成、脓毒症或出血是发病和死亡的最常见原因之一，它还显著导致住院时间延长和住院费用增加。为降低术后胰瘘的发生率，人们开发了许多手术方法。然而，胰肠重建的最佳技术仍存在争议。在此，我们描述了对35例连续胰十二指肠切除术的中期分析，所有手术均采用相同的标准化技术，该技术将用于胰管对黏膜胰空肠吻合的显微外科技术与常规使用纤维蛋白密封剂相结合。胰空肠吻合口漏发生率为5.7%（n = 2），均为A级瘘，采用保守治疗。放大器械和用于胰管对黏膜吻合的显微外科技术的精度提高，再加上对胰肠吻合口的常规封闭，是有效处理胰腺残端的关键因素。所取得的良好结果，尤其是极低的瘘发生率表明，这种技术方案是胰十二指肠切除术后胰腺重建的一种安全、可行且可靠的方法。
