Boralkar Ajay K, Rafe Abdul, Varudkar Anagha S, Vikram Singh Kunal
Surgical Oncology, Government Cancer Hospital, Aurangabad, IND.
Cureus. 2022 Jun 23;14(6):e26227. doi: 10.7759/cureus.26227. eCollection 2022 Jun.
Pancreato-duodenal resections are commonly done for periampullary carcinomas. The outcome of the procedure is decided by pancreato-enterostomy. Pancreato-jejunostomy (PJ) has been employed largely as pancreato-enterostomy. Recently, there has been a renewed interest in pancreato-gastrostomy (PG). The debate continues on the choice of reconstruction.
A hundred cases of periampullary carcinoma were subjected to modified pancreatico-gastrostomy. The pancreatico-gastrectomy was evaluated by drain fluid amylase done on days 1, 3, and 5 post-operatively and clinical findings. The leaks were classified according to the International Study Group of Pancreatic Fistula (ISGPF) classification of biochemical leaks, postoperative pancreatic fistula (POPF) B and POPF C. The leaks were evaluated against pancreatic factors like duct diameter, consistency of the pancreas, the thickness of the pancreatic neck, and duct location. Observations: Eighty percent of patients had no leaks. The biochemical leak was seen in 10% of cases. POPF B and C were observed at 5% each. Mortality was 3%. The diameter of the pancreatic duct of more than 3 mm and the firm consistency of the pancreas were favourable factors in the outcome of the anastomosis.
A modified pancreatico-gastrostomy technique appears to be technically feasible and safe. The leak rates and mortality appear to be low. We need a higher number of patients to confirm the efficacy of this modified pancreatico-enterostomy.
胰十二指肠切除术常用于壶腹周围癌。该手术的结果取决于胰肠吻合术。胰空肠吻合术（PJ）在很大程度上已被用作胰肠吻合术。最近，人们对胰胃吻合术（PG）重新产生了兴趣。关于重建方式的选择争论仍在继续。
对100例壶腹周围癌患者实施改良胰胃吻合术。通过术后第1、3和5天的引流液淀粉酶检测及临床检查对胰胃吻合术进行评估。根据国际胰腺瘘研究组（ISGPF）对生化瘘、术后胰瘘（POPF）B和POPF C的分类对瘘进行分类。根据胰管直径、胰腺质地、胰颈厚度和胰管位置等胰腺因素对瘘进行评估。观察结果：80%的患者无瘘。10%的病例出现生化瘘。POPF B和C各占5%。死亡率为3%。胰管直径大于3mm且胰腺质地坚实是吻合术结果的有利因素。
改良胰胃吻合术技术似乎在技术上可行且安全。瘘发生率和死亡率似乎较低。我们需要更多患者来证实这种改良胰肠吻合术的疗效。
