Zhang Binru, Li Le, Liu Hongyang, Li Linfeng, Wang Haonian, Li Yilong, Wang Yongwei, Sun Bei, Chen Hua
Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Gland Surg. 2023 Dec 26;12(12):1642-1653. doi: 10.21037/gs-23-340. Epub 2023 Dec 22.
The pancreatic reconstruction technique decides the incidence of postoperative pancreatic fistulas (POPF) in pancreaticoduodenectomy (PD). This study aims to evaluate the safety of modified single-needle continuous suture (SNCS) of duct-to-mucosa and compare the efficacy with double-layer continuous suture (DLCS) of duct-mucosa pancreaticojejunostomy (PJ) in open PD (OPD).
A total of 266 patients that received PD between January 2019 and May 2023 were retrospectively analyzed. Among them, 130 patients underwent DLCS, and 136 patients underwent SNCS [73 OPD and 63 laparoscopic PD (LPD)]. The primary outcome was clinically relevant POPF (CR-POPF) according to the definition of the revised 2016 International Study Group of Pancreatic Fistula (ISGPF). Propensity score matching (PSM) was conducted to reduce confounding bias.
A total of 66 pairs were successfully matched using PSM in OPD. No significant difference was observed in the occurrence of CR-POPF between the two groups (9.1% 21.2%, P=0.052). However, the median duration of operation and PJ was shorter in the SNCS group. The incidence of CR-POPF in LPD was 9.5%. Furthermore, regarding the alternative fistula risk score (a-FRS), the CR-POPF rate were 2.1%, 10.5%, and 15.6% in low-, intermediate-, and high-risk groups (P=0.067).
The SNCS is a facile, safe, and effective PJ technique and does not increase the incidence of POPF, regardless of a-FRS stratification, pancreatic texture, and main pancreatic duct (MPD) size.
胰腺重建技术决定了胰十二指肠切除术（PD）术后胰瘘（POPF）的发生率。本研究旨在评估改良单针连续黏膜对黏膜缝合（SNCS）的安全性，并比较其与开放胰十二指肠切除术（OPD）中胰肠吻合术（PJ）的双层连续缝合（DLCS）的疗效。
回顾性分析2019年1月至2023年5月期间接受PD的266例患者。其中，130例患者接受了DLCS，136例患者接受了SNCS[73例OPD和63例腹腔镜胰十二指肠切除术（LPD）]。根据2016年修订的国际胰瘘研究组（ISGPF）的定义，主要结局为临床相关胰瘘（CR-POPF）。采用倾向评分匹配（PSM）以减少混杂偏倚。
在OPD中，共成功匹配了66对。两组之间CR-POPF的发生率无显著差异（9.1%对21.2%，P=0.052）。然而，SNCS组的中位手术时间和PJ时间较短。LPD中CR-POPF的发生率为9.5%。此外，关于替代瘘风险评分（a-FRS），低、中、高风险组的CR-POPF发生率分别为2.1%、10.5%和15.6%（P=0.067）。
SNCS是一种简便、安全且有效的PJ技术，无论a-FRS分层、胰腺质地和主胰管（MPD）大小如何，均不会增加POPF的发生率。
