General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy.
EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy.
J Gastrointest Surg. 2017 Dec;21(12):2090-2099. doi: 10.1007/s11605-017-3587-7. Epub 2017 Sep 21.
The treatment of pancreatic stump is a critical step of pancreatoduodenectomy (PD) because leaks from this anastomosis incur major morbidity and mortality. We describe the technical details of a modified end-to-side pancreatojejunostomy (mPJ), and report on the outcome of the first 100 patients.
From October 2008 to June 2017, 424 pancreatic resections were performed, of which 203 were PD. The mPJ was introduced in November 2010 and used in 100 consecutive patients, by a single surgeon. Data were retrieved from a prospectively collected Institutional database, and used for the present retrospective evaluation. Post-operative pancreatic fistulas (POPF) were stratified with the Fistula Risk Score (FRS), based on the 2005-International Study Group of Pancreatic Fistula classification (ISGPFc) and on the subsequent 2016-revised version (ISGPSc).
ISGPFc POPF occurred in 17/100 (17%): grade A in 10/100 (10%), grade B in 6/100 (6%) and grade C in 1/100 (1%). On the ISGPSc, POPF rate averaged 7%: grade B in 6/100 (6%) and grade C in 1/100 (1%). POPF rate associated with high FRS was 18.8%/6.3% (ISGPFc/ISGPSc). With low and intermediate FRS, POPFs were 5.3%/0% (ISGPFc/ISGPSc) and 21.3%/9.8% (ISGPFc/ISGPSc) respectively. Re-operation rate was 3%. In-hospital mortality rate was 2% and specific mortality rate for POPF was 1%.
The mPJ technique is associated with a POPF rate which was less than expected, especially for "difficult" pancreas with high FRS (soft gland texture and small duct). A larger prospective series is needed in addition to comparative studies with other techniques for robust assessment.
胰肠吻合术是胰十二指肠切除术（PD）的关键步骤，因为该吻合口漏会导致严重的发病率和死亡率。我们描述了改良端侧胰肠吻合术（mPJ）的技术细节，并报告了前 100 例患者的结果。
从 2008 年 10 月至 2017 年 6 月，共进行了 424 例胰腺切除术，其中 203 例行 PD。mPJ 于 2010 年 11 月引入，并由一位外科医生连续应用于 100 例连续患者。数据取自一个前瞻性收集的机构数据库，并用于本次回顾性评估。术后胰瘘（POPF）根据 2005 年国际胰腺瘘研究组分类（ISGPFc）和随后的 2016 年修订版（ISGPSc）进行 Fistula Risk Score（FRS）分层。
ISGPFc POPF 发生在 17/100（17%）例中：100 例中，A级 10 例（10%），B 级 6 例（6%），C 级 1 例（1%）。在 ISGPSc 中，POPF 发生率平均为 7%：B 级 6 例（6%），C 级 1 例（1%）。高 FRS 相关的 POPF 发生率为 18.8%/6.3%（ISGPFc/ISGPSc）。低和中 FRS 时，POPF 发生率分别为 5.3%/0%（ISGPFc/ISGPSc）和 21.3%/9.8%（ISGPFc/ISGPSc）。再次手术率为 3%。住院死亡率为 2%，POPF 的特定死亡率为 1%。
mPJ 技术与预期相比，POPF 发生率较低，特别是对于 FRS 较高（质地柔软的胰腺和小导管）的“困难”胰腺。需要更大的前瞻性系列研究，以及与其他技术的比较研究，以进行稳健评估。
