Kaneda Yuji, Kimura Yuki, Saito Akira, Ae Ryusuke, Kawahira Hiroshi, Sata Naohiro
Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, JPN.
Medical Simulation Center, Jichi Medical University, Shimotsuke, JPN.
Cureus. 2023 Sep 6;15(9):e44771. doi: 10.7759/cureus.44771. eCollection 2023 Sep.
Introduction Postoperative pancreatic fistula (POPF) is a critical complication occurring with a high incidence after distal pancreatectomy. To minimize the risk of POPF, we developed an innovative pancreas ligation device capable of closing the pancreatic stump without causing traumatic injury to the pancreatic duct and artery. We conducted an follow-up study to compare the pressure resistance of the pancreas ligation device with that of a regular linear stapler. Materials and methods The pancreases were excised from 20 pigs and divided into two groups: ligation group ( = 10) and stapler group ( = 10). Distal pancreatectomy was performed, and the pancreatic stump was closed using either a pancreas ligation device or a regular linear stapler. The main pancreatic duct was cannulated with a 4-French catheter connected to a cannula and syringe filled with contrast medium. Using fluoroscopy detection, pressure resistance was defined as the maximum pressure without leakage from the pancreatic stump. Results No significant differences were found between the two groups regarding sex, age, body weight, or pancreatic thickness. In the ligation group, no leakage was observed at the stump in any pancreas. However, in the stapler group, six of 10 pancreases showed leakage at the staple line or into the parenchyma. Pressure resistance was significantly higher in the ligation group than in the stapler group (median: 42.8 vs. 34.3 mmHg, = 0.023). Conclusions These findings suggest the effectiveness of a pancreas ligation device in reducing the incidence of POPF after distal pancreatectomy. Our ligation device is expected to be a useful alternative to a linear stapler for pancreatic stump closure.
引言
术后胰瘘（POPF）是胰体尾切除术后常见且严重的并发症。为降低POPF风险，我们研发了一种创新型胰腺结扎装置，该装置能闭合胰腺残端，同时避免对胰管和动脉造成创伤。我们开展了一项随访研究，比较胰腺结扎装置与常规线性吻合器的抗压能力。
材料与方法
从20头猪身上切除胰腺，分为两组：结扎组（n = 10）和吻合器组（n = 10）。进行胰体尾切除术，分别使用胰腺结扎装置或常规线性吻合器闭合胰腺残端。用连接套管和充满造影剂注射器的4号法国导管插入主胰管。通过荧光透视检测，将抗压能力定义为胰腺残端无渗漏的最大压力。
结果
两组在性别、年龄、体重或胰腺厚度方面无显著差异。结扎组中，所有胰腺残端均未观察到渗漏。然而，在吻合器组中，10个胰腺中有6个在吻合线处或实质内出现渗漏。结扎组的抗压能力显著高于吻合器组（中位数：42.8 vs. 34.3 mmHg，P = 0.023）。
结论
这些结果表明胰腺结扎装置在降低胰体尾切除术后POPF发生率方面是有效的。我们的结扎装置有望成为用于闭合胰腺残端的线性吻合器的有效替代方案。
