胰十二指肠切除术中胰肠吻合的个体化选择
The individualized selection of Pancreaticoenteric anastomosis in Pancreaticoduodenectomy.
作者信息
Jin Ke-Min, Liu Wei, Wang Kun, Bao Quan, Wang Hong-Wei, Xing Bao-Cai
机构信息
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepatobiliary and Pancreatic Surgery Unit I, Peking University Cancer Hospital & Institute, No. 52, Fu-Cheng Road, Beijing, 100142, PR China.
出版信息
BMC Surg. 2020 Jun 22;20(1):140. doi: 10.1186/s12893-020-00791-y.
BACKGROUND
The mortality following pancreaticoduodenectomy has markedly decreased but remains an important challenge for the complexity of operation and technical skills involved. The present study aimed to clarify the impact of individualized pancreaticoenteric anastomosis and management to postoperative pancreatic fistula.
METHODS
Data from 529 consecutive pancreaticoduodenectomies were retrospectively analysed from the Hepatobiliary and Pancreatic Surgery Unit I, Peking Cancer Hospital. The pancreaticoenteric anastomosis was determined based on the pancreatic texture and diameter of the main pancreatic duct. The amylase value of the drainage fluid was dynamically monitored postoperatively on days 3, 5 and 7. A low speed intermittent irrigation was performed in selected patients. Intraoperative and postoperative results were collected and compared between the pancreaticogastrostomy (PG) group and pancreaticojejunostomy (PJ) group.
RESULTS
From 2010 to 2019, 529 consecutive patients underwent pancreaticoduodenectomy. Pancreaticogastrostomy was performed in 364 patients; pancreaticojejunostomy was performed in 150 patients respectively. The clinically relevant pancreatic fistula (CR-POPF) was 9.8% and mortality was zero. The soft pancreas, diameter of main pancreatic duct≤3 mm, BMI ≥ 25, operation time > 330 min and pancreaticogastrostomy was correlated with postoperative pancreatic fistula significantly. The CR-POPF of PJ was significantly higher than that of PG in soft pancreas patients; the operation time of PJ was shorter than that of PG significantly in hard pancreas patients. Intraoperative blood loss and operation time of PG was less than that of PJ significantly in normal pancreatic duct patients (p < 0.05).
CONCLUSIONS
Individualized pancreaticoenteric anastomosis should be determined based on the pancreatic texture and pancreatic duct diameter. The appropriate anastomosis and postoperative management could prevent mortality.
背景
胰十二指肠切除术后的死亡率已显著下降，但由于手术复杂性和所涉及的技术技能，其仍然是一项重大挑战。本研究旨在阐明个体化胰肠吻合术及管理对术后胰瘘的影响。
方法
对北京肿瘤医院肝胆胰外科一病区连续529例行胰十二指肠切除术患者的数据进行回顾性分析。根据胰腺质地和主胰管直径确定胰肠吻合方式。术后第3、5和7天动态监测引流液淀粉酶值。对部分患者进行低速间歇性冲洗。收集并比较胰胃吻合术（PG）组和胰空肠吻合术（PJ）组的术中及术后结果。
结果
2010年至2019年，连续529例患者接受了胰十二指肠切除术。364例患者行胰胃吻合术；150例患者行胰空肠吻合术。临床相关胰瘘（CR-POPF）发生率为9.8%，死亡率为零。软胰腺、主胰管直径≤3mm、BMI≥25、手术时间>330分钟及胰胃吻合术与术后胰瘘显著相关。软胰腺患者中，PJ组的CR-POPF显著高于PG组；硬胰腺患者中，PJ组的手术时间显著短于PG组。正常胰管患者中，PG组的术中出血量和手术时间显著少于PJ组（p<0.05）。
结论
应根据胰腺质地和胰管直径确定个体化胰肠吻合方式。合适的吻合方式及术后管理可预防死亡。
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