Nagakawa Yuichi, Takishita Chie, Hijikata Yosuke, Osakabe Hiroaki, Nishino Hitoe, Akashi Masanori, Nakajima Tetsushi, Shirota Tomoki, Sahara Yatsuka, Hosokawa Yuichi, Ishizaki Tetsuo, Katsumata Kenji, Tsuchida Akihiko
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Medicine (Baltimore). 2020 Mar;99(10):e19474. doi: 10.1097/MD.0000000000019474.
The modified Blumgart method for pancreaticojejunostomy has been shown to reduce the rate of postoperative pancreatic fistula (POPF) in open surgery. We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group).The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39-79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53-105 min, P < .001).Although the modified Blumgart pancreaticojejunostomy using LAPRA-TY suture clips did not improve the pancreatic fistula rate, it allowed for shorter operative times. Thus, this procedure lends itself to positive surgical and patient outcomes.
改良的Blumgart胰空肠吻合术已被证明可降低开放手术中术后胰瘘（POPF）的发生率。我们描述了一种使用LAPRA-TY缝合夹来辅助腹腔镜胰空肠吻合术的改良Blumgart方法。我们准备了一根双臂4-0不可吸收单丝缝线，在尾端使用LAPRA-TY夹结扎，长度为12厘米。接下来，将U形缝线穿过胰腺残端和空肠的浆肌层。我们用5-0可吸收单丝进行胰管对黏膜缝合。完成胰管对黏膜缝合后，作为最后一步，我们将缝线穿过空肠腹侧的浆肌层，并用LAPRA-TY夹紧紧固定线头。我们在39例患者的胰十二指肠切除术中进行了腹腔镜Blumgart胰空肠吻合术。我们将19例使用LAPRA-TY夹进行Blumgart胰空肠吻合术的患者（LAPRA-TY组）与20例未使用LAPRA-TY夹进行手术的患者（传统组）的手术结果进行了比较。LAPRA-TY组临床相关术后胰瘘的发生率为21.1%，与传统组的发生率无显著差异。然而，LAPRA-TY组胰空肠吻合术的平均时间为56.2分钟（范围为39-79分钟），明显短于传统组（69.7分钟；范围为53-105分钟，P<0.001）。虽然使用LAPRA-TY缝合夹的改良Blumgart胰空肠吻合术并未提高胰瘘发生率，但它缩短了手术时间。因此，该手术有助于取得积极的手术和患者预后。
