Wang Min, Xu Simiao, Zhang Hang, Peng Shuyou, Zhu Feng, Qin Renyi
Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China.
Department of Endocrinology, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Surg Endosc. 2017 Apr;31(4):1986-1992. doi: 10.1007/s00464-016-4805-1. Epub 2017 Jan 11.
LPD has been cautiously regarded as feasible and safe for resection and reconstruction. However, anastomosis of the remnant pancreas is still thought to be a critical obstacle to the dissemination of LPD in general practice. This study presents a new technique of pancreaticojejunostomy for nondilated pancreatic duct and evaluates its safety and reliability.
From July 2014 to June 2015, a total of 52 patients underwent LPD with the new technique. A modified technique of duct-to-mucosa PJ was performed with transpancreatic interlocking mattress sutures, named the imbedding duct-to-mucosa PJ. Then the morbidity and mortality was calculated.
This technique was applied in 52 patients after LPD all with nondilated pancreatic duct (1-3 mm). The mean operation time was 4.6 h (range, 3.5-8.3 h) and the median time for the anastomosis was 37 min (range, 24-53 min). Operative mortality was zero, and morbidity was 21.2 % (n = 11), including hemorrhage (n = 3, 5.8 %), biliary fistula (n = 1, 1.9 %), pulmonary infection (n = 1, 1.9 %), delayed gastric emptying (n = 2, 3.8 %), abdominal abscess caused by biliary fistula or PF formation (n = 2, 3.8 %), and POPF (n = 2, 3.8 %). Two patients developed a pancreatic fistula (one type A, one type B) classified according to the International Study Group on Pancreatic Fistula.
The described technique is a simple and safe reconstruction procedure after LPD, especially for patients with nondilated pancreatic duct.
腹腔镜胰十二指肠切除术（LPD）已被谨慎地认为对于切除和重建是可行且安全的。然而，残余胰腺的吻合术仍被认为是LPD在常规实践中广泛应用的关键障碍。本研究提出了一种针对非扩张性胰管的胰空肠吻合新技术，并评估其安全性和可靠性。
2014年7月至2015年6月，共有52例患者采用新技术接受了LPD。采用经胰腺的连锁褥式缝合进行改良的导管对黏膜胰空肠吻合术，称为嵌入式导管对黏膜胰空肠吻合术。然后计算发病率和死亡率。
该技术应用于52例LPD术后患者，所有患者的胰管均未扩张（1-3毫米）。平均手术时间为4.6小时（范围3.5-8.3小时），吻合术的中位时间为37分钟（范围24-53分钟）。手术死亡率为零，发病率为21.2%（n=11），包括出血（n=3，5.8%）、胆瘘（n=1，1.9%）、肺部感染（n=1，1.9%）、胃排空延迟（n=2，3.8%）、胆瘘或胰瘘形成引起的腹腔脓肿（n=2，3.8%）以及胰瘘（n=2，3.8%）。两名患者根据国际胰瘘研究小组的分类发生了胰瘘（1例A型，1例B型）。
所描述的技术是LPD术后一种简单且安全的重建方法，尤其适用于胰管未扩张的患者。
