Wang Zheng-Feng, Zhang Bo, Xu Hao, Zhou Wen-Ce
The Fourth Ward of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
The Second Hospital of Lanzhou University, Lanzhou, China.
Front Oncol. 2024 Apr 16;14:1347752. doi: 10.3389/fonc.2024.1347752. eCollection 2024.
The five-needle pancreato-intestinal anastomosis method is used in laparoscopic pancreaticoduodenectomy (LPD). The aim of this study was to explore the clinical efficacy and adverse reactions of this new surgical method and to provide a scientific reference for promoting this new surgical method in the future.
A single-centre observational study was conducted to evaluate the safety and practicality of the five-needle method for pancreatojejunostomy in LPD surgeries. The clinical data of 78 patients who were diagnosed with periampullary malignancies and underwent LPD were collected from the 1 of August 2020 to the 31 of June 2023 at Lanzhou University First Hospital. Forty-three patients were treated with the 'Five-Needle' method (test groups), and 35 patients were treated with the 'Duct-to-Mucosa' method (control group) for pancreatojejunostomy. These two methods are the most commonly used and highly preferred pancreatointestinal anastomosis methods worldwide. The primary outcome was pancreatic fistula, and the incidence of which was compared between the two groups.
The incidence of pancreatic fistula in the five-needle method group and the duct-to-mucosa method group was not significantly different (25.6% vs. 28.6%, p=0.767). Additionally, there were no significant differences between the two groups in terms of intraoperative blood loss (Z=-1.330, p=0.183), postoperative haemorrhage rates (p=0.998), length of postoperative hospital stay (Z=-0.714, p=0.475), bile leakage rate (p=0.745), or perioperative mortality rate (p=0.999). However, the operative time in the 'Five-Needle' method group was significantly shorter than that in the 'Duct-to-Mucosa' method group (270 ± 170 mins vs. 300 ± 210 mins, Z=-2.336, p=0.019). Further analysis revealed that in patients with pancreatic ducts smaller than 3 mm, the incidence of pancreatic fistula was lower for the 'Five-Needle' method than for the 'Duct-to-Mucosa' method (12.5% vs. 53.8%, p=0.007).
The five-needle method is safe and efficient for pancreatojejunostomy in LPD, and is particularly suitable for anastomosis in nondilated pancreatic ducts. It is a promising, valuable, and recommendable surgical method worthy of wider adoption.
五针法胰肠吻合术应用于腹腔镜胰十二指肠切除术（LPD）。本研究旨在探讨这种新手术方法的临床疗效和不良反应，为今后推广该新手术方法提供科学参考。
进行一项单中心观察性研究，以评估五针法在LPD手术中行胰肠吻合术的安全性和实用性。收集2020年8月1日至2023年6月31日在兰州大学第一医院诊断为壶腹周围恶性肿瘤并接受LPD的78例患者的临床资料。43例患者采用“五针法”（试验组）行胰肠吻合术，35例患者采用“导管对黏膜法”（对照组）行胰肠吻合术。这两种方法是全球最常用且备受青睐的胰肠吻合方法。主要结局为胰瘘，并比较两组的发生率。
五针法组和导管对黏膜法组的胰瘘发生率无显著差异（25.6%对28.6%，p = 0.767）。此外，两组在术中出血量（Z = -1.330，p = 0.183）、术后出血率（p = 0.998）、术后住院时间（Z = -0.714，p = 0.475）、胆漏率（p = 0.745）或围手术期死亡率（p = 0.999）方面均无显著差异。然而，“五针法”组的手术时间明显短于“导管对黏膜法”组（270±170分钟对300±210分钟，Z = -2.336，p = 0.019）。进一步分析显示，在胰管小于3mm的患者中，“五针法”的胰瘘发生率低于“导管对黏膜法”（12.5%对53.8%，p = 0.007）。
五针法在LPD手术中行胰肠吻合术安全有效，尤其适用于未扩张胰管的吻合。它是一种有前景、有价值且值得推荐的手术方法，值得更广泛采用。
