Kaneda Yuji, Kimura Yuki, Saito Akira, Ohzawa Hideyuki, Ae Ryusuke, Kawahira Hiroshi, Lefor Alan K, Sata Naohiro
Department of Surgery, Jichi Medical University, Shimotsuke, JPN.
Medical Simulation Center, Jichi Medical University, Shimotsuke, JPN.
Cureus. 2021 Sep 24;13(9):e18238. doi: 10.7759/cureus.18238. eCollection 2021 Sep.
Introduction Although new techniques and devices have been introduced, the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy remains high. To reduce the risk of POPF, we developed an innovative ligation band and conducted this pilot study to assess the possibility of reducing the incidence of POPF and pancreatic necrosis after distal pancreatectomy. Methods Distal pancreatectomy was performed in three pigs. In two animals, ligation of the pancreas was performed while maintaining arterial blood flow to the stump, and in one animal, the arterial blood flow was occluded. After ligation, the pancreas was sharply divided. Animals were sacrificed seven days later, and the remnant pancreas was assessed histologically. POPF was defined as amylase in ascites > 3x the preoperative serum amylase level. The following equation was used to quantify the extent of necrotic tissue: necrotic tissue residual rate = necrotic tissue area/ cross-sectional area. Results All animals survived, and no POPF developed. For two animals in which arterial blood flow to the stump was maintained, necrotic tissue residual rates at the ligation line were 24% and 31%. At the pancreatic stump, necrotic tissue residual rates were 37% and 50%. In the animal in which arterial blood flow to the stump was occluded, the necrotic tissue residual rate at the ligation line was 83% and that at the pancreatic stump was 78%, both higher than that in animals in which arterial blood flow was maintained. In all animals, there was no injury to pancreatic tissue at the ligation line. Conclusion The pancreas ligation band can potentially prevent POPF after distal pancreatectomy by atraumatic ligation, and the band ligates the pancreatic stump while maintaining arterial blood flow and limiting pancreatic necrosis.
引言 尽管已引入新技术和设备，但胰体尾切除术后胰瘘（POPF）的发生率仍然很高。为降低POPF的风险，我们研发了一种创新的结扎带，并开展了这项前瞻性研究，以评估降低胰体尾切除术后POPF和胰腺坏死发生率的可能性。方法 对三头猪进行胰体尾切除术。在两只动物中，在保持残端动脉血流的同时进行胰腺结扎，在一只动物中，阻断动脉血流。结扎后，锐性切断胰腺。七天后处死动物，对残余胰腺进行组织学评估。POPF定义为腹水中淀粉酶>术前血清淀粉酶水平的3倍。采用以下公式量化坏死组织范围：坏死组织残留率=坏死组织面积/横截面积。结果 所有动物均存活，未发生POPF。对于两只保持残端动脉血流的动物，结扎线处的坏死组织残留率分别为24%和31%。在胰腺残端，坏死组织残留率分别为37%和50%。在阻断残端动脉血流的动物中，结扎线处的坏死组织残留率为83%，胰腺残端为78%，均高于保持动脉血流的动物。在所有动物中，结扎线处的胰腺组织均未受损。结论 胰腺结扎带可通过无创结扎潜在地预防胰体尾切除术后的POPF，该结扎带在保持动脉血流和限制胰腺坏死的同时结扎胰腺残端。
