Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Asian J Surg. 2021 Jan;44(1):286-291. doi: 10.1016/j.asjsur.2020.07.008. Epub 2020 Aug 7.
Discussions about pancreaticojejunostomy (PJ), which can reduce the incidence of postoperative pancreatic fistula (POPF) in pancreaticoduodenectomy (PD), are ongoing. Here we introduce the surgical technique of PJ performed at our hospital and analyze its safety and advantages.
We retrospectively analyzed 122 patients who underwent one-layer PJ using reinforcing sutures in PD. PJ was performed with reinforcing sutures on the pancreatic stump, including the insertion of a soft silastic catheter for internal drainage followed by suturing of the pancreas and jejunum with one layer.
Of the 122 patients who underwent PJ with this technique, 62 (50.8%) developed POPF. However, 37 (30.3%) had grade A that did not affect the hospital course. Critical POPF occurred in 25 patients: grade B in 20 (16.4%) and grade C in 5 (4.1%). There was no significant difference in the critical POPF patient group according to the pancreas related disease related to pancreatic texture.
Although this technique cannot prevent POPF, we noted no significant difference in POPF versus other surgical techniques. In addition, this technique, which was designed to increase pancreatic texture, is practical and simple for PJ. Therefore, the inexperienced hepatobiliary and pancreatic surgeon can perform it without major complications.
关于胰肠吻合术（PJ）的讨论仍在继续，该术式可降低胰十二指肠切除术（PD）后胰瘘（POPF）的发生率。在此，我们介绍我院实施的 PJ 手术技术，并分析其安全性和优势。
我们回顾性分析了 122 例行 PD 时采用加固缝线行一层式 PJ 的患者。PJ 采用加固缝线进行胰腺残端吻合，包括插入软性硅酮导管进行内引流，然后用一层缝线缝合胰腺和空肠。
在采用该技术行 PJ 的 122 例患者中，有 62 例（50.8%）发生了 POPF。然而，其中 37 例（30.3%）为不影响住院病程的 A 级。25 例患者发生了严重的 POPF：B 级 20 例（16.4%），C 级 5 例（4.1%）。根据与胰腺质地相关的胰腺相关疾病，严重 POPF 患者组之间无显著差异。
虽然该技术不能预防 POPF，但与其他手术技术相比，我们未发现 POPF 有显著差异。此外，该技术旨在增加胰腺质地，对于 PJ 来说是实用且简单的。因此，经验不足的肝胆胰外科医生可以在没有重大并发症的情况下实施该手术。
