Pachter H L, Pennington R, Chassin J, Spencer F C
Surgery. 1979 Feb;85(2):166-70.
The most serious complication following distal pancreatectomy is the development of a pancreatic fistula or subphrenic abscess. These complications are particularly prone to occur following distal pancreatectomy for trauma. The injured pancreas is divided in a contaminated field, often in the presence of hemorrhage and partly devitalized tissues, in which identification and secure closure of the transected pancreatic duct may be difficult. A review of 12 surgical publications describing experience with 234 distal pancreatectomies performed for trauma found the average pancreatic fistula rate to be 13% an in some reports as high as 25% to 30%. In an attempt to decrease the high postoperative fistula rate after distal pancreatectomy, transection of the gland with the autosuture has been investigated. There are at least three theoretical advantages of this technique. The pancreas is transected through healthy tissue, the pancreatic duct is closed securely, and stainless steel sutures are used, which probably are more resistant to the development of infection than other suture material. This report describes a technique of distal pancreatectomy for both trauma surgery and elective surgery with the TA-55 Auto Suture stapler. TA-55 Auto Suture stapler, with 3.5 mm staples, is placed across the mobilized pancreas, and two rows of staggered stainless steel staples are laid down. The gland distal to the stapler then is amputated. At present this technique has been used in a total of 12 cases--four for trauma and eight during elective procedures. One fistula related to pancreatectomy performed with the Auto Suture stapler developed, for a complication rate of 8.3%. This preliminary experience indicates that a more widespread evaluation of this technique is indicated.
胰体尾切除术后最严重的并发症是胰瘘或膈下脓肿的形成。这些并发症在因创伤行胰体尾切除术后尤其容易发生。受损的胰腺是在污染区域进行切断的，通常伴有出血和部分失活组织，在这种情况下，识别并牢固闭合切断的胰管可能很困难。一项对12篇外科文献的综述描述了234例因创伤行胰体尾切除术的经验，发现胰瘘的平均发生率为13%，在一些报道中高达25%至30%。为了降低胰体尾切除术后较高的术后瘘发生率，人们对使用自动缝合器切断胰腺进行了研究。该技术至少有三个理论优势。胰腺是通过健康组织切断的，胰管被牢固闭合，并且使用了不锈钢缝线，与其他缝合材料相比，不锈钢缝线可能更能抵抗感染的发生。本报告描述了一种使用TA - 55自动缝合器进行胰体尾切除术的技术，该技术可用于创伤手术和择期手术。TA - 55自动缝合器使用3.5毫米的缝钉，横跨游离的胰腺放置，然后放置两排交错的不锈钢缝钉。然后切除缝钉远端的腺体。目前，该技术共应用于12例患者——4例用于创伤手术，8例用于择期手术。使用自动缝合器进行胰体尾切除术后发生了1例与手术相关的胰瘘，并发症发生率为8.3%。这一初步经验表明，该技术需要进行更广泛的评估。
