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全腹腔镜胰十二指肠切除术中的胰胃吻合术——一种新型的胰胃吻合技术。

Pancreaticogastrostomy in pure laparoscopic pancreaticoduodenectomy--A novel pancreatic-gastric anastomosis technique.

作者信息

Matsuda Masamichi, Haruta Shusuke, Shinohara Hisashi, Sasaki Kazunari, Watanabe Goro

机构信息

Department of Surgery, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan.

出版信息

BMC Surg. 2015 Jul 2;15:80. doi: 10.1186/s12893-015-0061-x.

Abstract

BACKGROUND

Although many surgical procedures are now routinely performed laparoscopically, pure laparoscopic pancreaticoduodenectomy (LPD) is not commonly performed because of the technical difficulty of pancreatic resection and the associated reconstruction procedures. Several pancreatic-enteric anastomosis techniques for LPD have been reported, but most are adaptations of open procedures. To accomplish pure LPD, we consider it necessary to establish new pancreatic-enteric anastomosis techniques that are specifically developed for LPD and are safe and feasible to perform.

RESULTS

One patient developed a postoperative pancreatic fistula (International Study Group of Pancreatic Fistula criteria, grade B) and subsequent postoperative delayed gastric emptying (International Study Group of Pancreatic Surgery criteria, grade C). No other major complications occurred. We developed a novel pancreatic-gastric anastomosis technique that enabled us to safely perform pure LPD. The main pancreatic duct was stented with a 4-Fr polyvinyl catheter during pancreatic resection. A small hole was created in the posterior wall of the stomach and was bluntly dilated. A 5-cm incision was made in the anterior stomach, and the pancreatic drainage tube was passed into the stomach through the hole in the posterior wall. The remnant pancreas was pulled into the stomach, and was easily positioned and secured in place with only four to six sutures between the pancreatic capsule and the gastric mucosa. We used this technique to perform pure LPD in five patients between December 2012 and July 2013.

CONCLUSIONS

Our new technique is technically easy and provides secure fixation between the gastric wall and the pancreas. This technique does not require main pancreatic duct dilatation, and the risk of intra-abdominal abscess formation due to postoperative pancreatic fistula may be minimized. Although this technique requires further investigation as it may increase the risk of delayed gastric emptying, it may be a useful method of performing pancreaticogastrostomy in pure LPD.

TRIAL REGISTRATION

ISRCTN16761283 . Registered 16 January 2015.

摘要

背景

尽管现在许多外科手术都常规通过腹腔镜进行,但由于胰腺切除及相关重建手术的技术难度,单纯腹腔镜胰十二指肠切除术(LPD)并不常用。已有数种用于LPD的胰肠吻合技术被报道,但大多数是开放手术的改良。为完成单纯LPD,我们认为有必要建立专门为LPD开发的、安全可行的新型胰肠吻合技术。

结果

1例患者发生术后胰瘘(国际胰瘘研究组标准,B级)及随后的术后胃排空延迟(国际胰腺外科研究组标准,C级)。未发生其他严重并发症。我们开发了一种新型胰胃吻合技术,使我们能够安全地进行单纯LPD。在胰腺切除期间,用一根4Fr聚乙烯导管对主胰管进行支架置入。在胃后壁开一个小孔并钝性扩张。在胃前壁做一个5cm切口,将胰腺引流管通过后壁的孔送入胃内。将残余胰腺拉入胃内,仅在胰腺被膜与胃黏膜之间缝合4至6针即可轻松定位并固定到位。我们在2012年12月至2013年7月期间使用该技术对5例患者进行了单纯LPD。

结论

我们的新技术在技术上简单易行,能在胃壁和胰腺之间提供牢固固定。该技术无需扩张主胰管,可将术后胰瘘导致腹腔内脓肿形成的风险降至最低。尽管该技术可能会增加胃排空延迟的风险,需要进一步研究,但它可能是在单纯LPD中进行胰胃吻合术的一种有用方法。

试验注册

ISRCTN16761283。2015年1月16日注册。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1305/4487839/7e0bdf71c443/12893_2015_61_Fig1_HTML.jpg

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