Gurram Ram Prakash, S L Harilal, Gnanasekaran Senthil, Choudhury Satyaprakash Ray, Pottakkat Biju, Raja Kalayarasan
Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Department of Surgical Gastroenterology, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
Ann Hepatobiliary Pancreat Surg. 2023 May 31;27(2):211-216. doi: 10.14701/ahbps.22-098. Epub 2023 Mar 2.
It has been shown that external pancreatic ductal stenting (EPDS) can reduce the incidence of clinically relevant postoperative pancreatic fistula. Although studies have described EPDS in open pancreaticoduodenectomy (PD), EPDS in minimally invasive PD has not been reported yet. Thus, the objective of this study was to describe the technique of EPDS in minimally invasive PD. The procedure was performed either laparoscopically or using a robot. Once PD was completed, key steps included triple enterotomy, threading of silk-suture through all enterotomies and exteriorization, completing posterior layer of pancreaticojejunostomy (PJ), railroading stent through preplaced silk-suture, intubation of stent into the pancreatic duct, completion of PJ, followed by hepaticojejunostomy and parietalization of jejunum at the stent exit site. EPDS in PD through a minimally invasive approach can be performed safely in selected cases with either a small-sized pancreatic duct or a soft pancreas.
已表明，胰外胆管支架置入术（EPDS）可降低临床相关术后胰瘘的发生率。尽管已有研究描述了开放胰十二指肠切除术（PD）中的EPDS，但微创PD中的EPDS尚未见报道。因此，本研究的目的是描述微创PD中EPDS的技术。该手术可通过腹腔镜或机器人进行。一旦完成PD，关键步骤包括三重肠切开术、丝线穿过所有肠切口并引出、完成胰空肠吻合术（PJ）的后层、将支架沿预先放置的丝线推送、将支架插入胰管、完成PJ，随后进行肝空肠吻合术以及在支架出口处将空肠固定于腹壁。通过微创方法在PD中进行EPDS在胰腺导管较小或胰腺质地柔软的特定病例中可安全实施。
