Department of General Surgery, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang City, 110004, Liaoning Province, China.
J Gastrointest Surg. 2022 Sep;26(9):1967-1981. doi: 10.1007/s11605-022-05339-4. Epub 2022 May 11.
Pancreaticojejunostomy, an independent risk factor for pancreatic fistula, is the cause of several postoperative complications of pancreaticoduodenectomy. As suturing in minimally invasive surgery is difficult to perform, more simplified methods are needed to guarantee a safe pancreatic anastomosis. The concept of "biological healing" proposed in recent years has changed the conventional understanding of the anastomosis, which recommends rich blood supply, low tension, and loose sutures in the reconstruction of the pancreatic outflow tract.
A literature search was conducted in PubMed for articles on pancreaticojejunostomy published between January 2014 and December 2021. After following a due selection process, several techniques developed in accordance with the concept of biological healing that were found suitable for minimally invasive surgery and their related clinical outcomes were described in this review.
The incidence of clinically relevant pancreatic fistula associated with the presented techniques did not exceed 15.9%, indicating superior results compared to Cattell-Warren double-layer duct-to-mucosa anastomosis (incidence: approximately 20%). The features and drawbacks of these approaches have been enumerated from the viewpoint of biological healing.
This review described several modified pancreaticojejunostomy techniques with the advantages of a simplified procedure and a lower incidence of pancreatic fistula. Surgeons can choose to apply them in clinical practice to improve patient prognosis.
胰肠吻合术是胰瘘的独立危险因素，也是胰十二指肠切除术术后多种并发症的原因。由于微创手术中的缝合操作较为困难，因此需要更简化的方法来保证安全的胰腺吻合。近年来提出的“生物愈合”理念改变了人们对吻合的传统认识，建议在胰液流出道重建中保证丰富的血供、低张力和宽松的缝合。
在 PubMed 上检索了 2014 年 1 月至 2021 年 12 月发表的有关胰肠吻合术的文章。经过适当的选择过程，本文描述了几种符合生物愈合理念并适合微创手术的技术，以及它们的相关临床结果。
所介绍技术相关的临床显著胰瘘发生率不超过 15.9%，优于 Cattell-Warren 双层套入式黏膜对黏膜吻合术（发生率：约 20%）。从生物愈合的角度列举了这些方法的特点和缺点。
本文描述了几种改良的胰肠吻合技术，其具有操作简化和降低胰瘘发生率的优点。外科医生可以选择在临床实践中应用这些技术，以改善患者的预后。
