Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain.
Department of Surgery, Centre Hospitalier du Luxembourg, Luxembourg.
Surgeon. 2020 Jun;18(3):137-141. doi: 10.1016/j.surge.2019.07.002. Epub 2019 Aug 21.
Longitudinal pancreaticojejunostomy, also known as modified Puestow or Partington-Rochelle procedure, is a technique for the treatment of chronic pancreatitis. It is usually performed by laparotomy, but in a very small number of cases it has been performed using a laparoscopic or robot-assisted approach. We carried out a systematic literature review to clarify the current status of laparoscopic longitudinal pancreatojejunostomy (LLPJ).
Adhering to the PRISMA guidelines, a systematic search for LLPJ was performed in PubMed, Embase, and Cochrane Library, for articles published up to 31 December 2017.
357 articles were evaluated for eligibility and 17 were included for critical appraisal: eight case reports, eight retrospective case series, and one series of cases and controls without randomization. All of them had a grade of recommendation C and a level of evidence 4 according to the CEBM. Patients were relatively young (mean age 37 years), with a slight preponderance of males (ratio 1.3: 1). All had long-standing disease, ERCP prior to surgery and a dilated pancreatic duct (mean 11 mm). The surgery was usually performed laparoscopically using four trocars; the conversion rate was low (5%), bleeding was minimal, the morbidity rate was 11% and no mortality was reported. Mean hospital stay was 5.6 days. The follow-up period varied but was usually short (less than two years). The results for pain control were very good since 90% of patients reported no pain, although visual analog scales were rarely used.
In conclusion, LLPJ seems to be a safe, feasible and effective technique in patients with chronic pancreatitis. However, the number of descriptions published to date is very small, and there are no studies with high scientific evidence comparing LLPJ with open surgery or with endoscopic treatment that would allow us to draw firmer conclusions at the present time.
纵向胰肠吻合术，也称为改良 Puestow 或 Partington-Rochelle 手术，是一种治疗慢性胰腺炎的技术。它通常通过剖腹手术进行，但在极少数情况下，也可以通过腹腔镜或机器人辅助方法进行。我们进行了系统的文献回顾，以阐明腹腔镜下纵向胰肠吻合术（LLPJ）的现状。
根据 PRISMA 指南，在 PubMed、Embase 和 Cochrane Library 中进行了系统搜索，以获取截至 2017 年 12 月 31 日发表的 LLPJ 相关文章。
评估了 357 篇文章的资格，纳入了 17 篇文章进行批判性评估：8 篇病例报告、8 篇回顾性病例系列和 1 篇无随机分组的病例和对照系列。根据 CEBM，所有文章的推荐等级均为 C 级，证据水平均为 4 级。患者相对年轻（平均年龄 37 岁），男性略占优势（比例为 1.3:1）。所有患者均患有长期疾病，手术前均行 ERCP，且胰管扩张（平均直径 11mm）。手术通常使用四个 trocar 进行腹腔镜操作；转化率低（5%），出血少，发病率为 11%，无死亡报告。平均住院时间为 5.6 天。随访期不同，但通常较短（不到两年）。疼痛控制的结果非常好，因为 90%的患者报告无疼痛，尽管很少使用视觉模拟量表。
总之，LLPJ 似乎是一种安全、可行且有效的慢性胰腺炎患者治疗技术。然而，迄今为止发表的描述数量非常少，也没有具有高科学证据的研究将 LLPJ 与开放手术或内镜治疗进行比较，因此目前我们无法得出更确定的结论。
