Sugiura Teiichi, Uesaka Katsuhiko, Ashida Ryo, Ohgi Katsuhisa, Okamura Yukiyasu, Yamada Mihoko, Otsuka Shimpei
From the Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Ann Surg Open. 2021 Dec 10;2(4):e112. doi: 10.1097/AS9.0000000000000112. eCollection 2021 Dec.
To review our novel technique of hepatopancreatoduodenectomy (HPD) with delayed division of the pancreatic parenchyma (DDPP) for reducing postoperative pancreatic fistula (POPF).
The high operative morbidity and mortality rates after HPD remains a major issue. One of the most troublesome complications is POPF, which might possibly be caused by peripancreatic saponification due to long interval between pancreas resection and reconstruction, as most surgeons prefer a caudocranial approach, performing pancreatoduodenectomy (PD) first and then hepatectomy (conventional HPD [C-HPD]).
A review of the patients undergoing C-HPD and HPD with DDPP was performed. Postoperative outcomes were compared. Multivariable analysis was conducted to evaluate the risk factors of POPF after HPD.
One-hundred two patients comprised of 50 patients undergoing C-HPD and 52 patients undergoing HPD with DDPP. The interval between pancreas resection and reconstruction was significantly shorter in HPD with DDPP group than in C-HPD group (51 vs 263 minutes; < 0.001). The incidence of POPF was significantly lower in HPD with DDPP group than in C-HPD group (32.7% vs 77.3%; < 0.001). The postoperative hospital stay was shorter in patients undergoing HPD with DDPP than in those undergoing C-HPD (32 vs 45 days). A multivariate analysis revealed that body mass index >24 kg/m and conventional (PD first) procedure were significant risk factors for POPF after HPD.
A novel technique of HPD with DDPP is a simple procedure and the optimal treatment choice to reduce the risk of developing POPF after this extensive surgery.
回顾我们采用胰腺实质延迟离断术（DDPP）行肝胰十二指肠切除术（HPD）以降低术后胰瘘（POPF）的新技术。
HPD术后较高的手术发病率和死亡率仍是一个主要问题。最棘手的并发症之一是POPF，这可能是由于胰腺切除与重建之间间隔时间长导致胰周皂化，因为大多数外科医生倾向于采用尾侧至头侧的手术入路，先进行胰十二指肠切除术（PD），然后进行肝切除术（传统HPD [C-HPD]）。
对接受C-HPD和采用DDPP的HPD患者进行回顾性研究。比较术后结果。进行多变量分析以评估HPD术后POPF的危险因素。
102例患者中，50例接受C-HPD，52例接受采用DDPP的HPD。采用DDPP的HPD组胰腺切除与重建之间的间隔时间明显短于C-HPD组（51分钟对263分钟；P<0.001）。采用DDPP的HPD组POPF的发生率明显低于C-HPD组（32.7%对77.3%；P<0.001）。采用DDPP的HPD患者术后住院时间短于接受C-HPD的患者（32天对45天）。多变量分析显示，体重指数>24 kg/m²和传统（先进行PD）手术方式是HPD术后POPF的重要危险因素。
采用DDPP的HPD新技术是一种简单的手术方法，是降低这种大型手术后发生POPF风险的最佳治疗选择。
