Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, 240001, Anhui, People's Republic of China.
Updates Surg. 2023 Aug;75(5):1117-1122. doi: 10.1007/s13304-023-01468-w. Epub 2023 Feb 25.
Laparoscopic techniques have been widely used in pancreatic surgery, such as laparoscopic pancreaticoduodenectomy (LPD) and laparoscopic central pancreatectomy (LCP). Laparoscopic pancreaticojejunostomy (LPJ) is a common procedure for LPD and LCP, and is also the most critical. The quality of LPJ is associated with the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF). Although LPJ technology has been greatly improved, CR-POPF cannot be completely avoided especially to soft pancreas, which is an important reason for the high risk of laparoscopic pancreatic surgery. To date, there is a lack of standard LPJ approaches. Here, we report a U-shaped suture reinforcement for soft pancreatic section combined with penetrating pancreaticojejunostomy (PPJ) technique, called U-PPJ. Twenty-three patients with soft pancreas who underwent laparoscopic pancreatic surgery adopting U-PPJ method between 2017 and 2022 were enrolled (LPD = 19, LCP = 4). Preoperative, intraoperative and postoperative indexes were collected and analyzed. The results showed that all patients treated with U-PPJ were discharged without drainage tube or a small amount of exudate in the drainage tube does not require clinical treatment, but only needs to be removed after 2 days of observation. The average operation time was 417.35 min. The intraoperative blood loss was 171.74 ml. The pancreatic duct diameter was 3.41 mm. The average postoperative hospitalization days were 11.83 days. The average postoperative drainage tube removal time was 13.26 days. The incidence of postoperative B-grade pancreatic fistula was 4.3%, and no C-grade pancreatic fistula occurred. In our experience, U-PPJ can be completed by a skilled surgeon in less than 20 min. U-PPJ is safe, reliable, convenient and has a low incidence of CR-POPF in soft pancreas, which is worthy of clinical application. It also provides more options for laparoscopic pancreatic surgery. Since this is a retrospective study with a small number of cases, more prospective multicenter studies are needed to further verify its safety and efficacy.
腹腔镜技术已广泛应用于胰腺外科，如腹腔镜胰十二指肠切除术（LPD）和腹腔镜胰体尾切除术（LCP）。腹腔镜胰肠吻合术（LPJ）是 LPD 和 LCP 的常见手术，也是最关键的手术。LPJ 的质量与临床相关的术后胰瘘（CR-POPF）的发生有关。尽管 LPJ 技术已经得到了很大的改进，但特别是对于软胰腺，CR-POPF 仍无法完全避免，这是腹腔镜胰腺手术高风险的一个重要原因。迄今为止，还缺乏 LPJ 的标准方法。在这里，我们报告了一种 U 形缝线加固软胰腺段联合穿透性胰肠吻合术（PPJ）技术，称为 U-PPJ。2017 年至 2022 年间，我们共收治了 23 例接受腹腔镜胰腺手术且采用 U-PPJ 方法的软胰腺患者（LPD=19 例，LCP=4 例）。收集并分析了患者的术前、术中及术后指标。结果显示，所有接受 U-PPJ 治疗的患者均未放置引流管或仅放置少量引流管，引流管内渗出物无需临床治疗，仅需观察 2 天后拔除。手术平均时间为 417.35 分钟，术中出血量为 171.74ml，胰管直径为 3.41mm，术后平均住院时间为 11.83 天，术后平均引流管拔除时间为 13.26 天。术后 B 级胰瘘发生率为 4.3%，无 C 级胰瘘发生。在我们的经验中，熟练的外科医生可以在不到 20 分钟内完成 U-PPJ。U-PPJ 在软胰腺中安全、可靠、方便，CR-POPF 发生率低，值得临床应用。它也为腹腔镜胰腺手术提供了更多选择。由于这是一项回顾性研究且病例数较少，需要更多前瞻性多中心研究进一步验证其安全性和有效性。
