Department of Surgical Oncology, Robotic and new Tecnology, Casa di Cura Cobellis, Vallo della Lucania, Salerno, Italy.
Department of Surgical, Oncological and Gastroenterological Sciences, DiSCOG, University of Padua, Padua, Italy.
Updates Surg. 2024 Oct;76(6):2471-2476. doi: 10.1007/s13304-024-01949-6. Epub 2024 Jul 16.
The intraoperative risk stratification during pancreatoduodenectomy is gaining increasing significance. The main pancreatic duct wall is of particular importance as it represents the element of anchor of the anastomotic stiches. This study aims to describe the safety, feasibility, and reproducibility of a novel intraductal ultrasonography of the main pancreatic (MPD)-Wirsung duct (IWU) during pancreatoduodenectomy (PD).A prospective series of 58 patients underwent PD with anastomosis between the MPD and the jejunum. Just before the reconstructive phase, the remaining pancreatic stump underwent complete IWU with definition of Wirsung thickness (WT) at the anastomotic site, using a radial ultrasound probe of 1.7 mm in diameter.No IWU-related complications were reported. The median WT of the MPD was 1.1 mm (SD 0.2). The rates of postoperative pancreatic fistula (POPF), major morbidity, and mortality were 17, 5, and 0%, respectively.The use of IWU during PD demonstrated safety and feasibility. IWU represents a new tool aimed at determining structural characteristics of the MPD that could impact on the surgical strategy of the pancreatic anastomosis. Further validation and comparative analysis with the current standard of care are warranted within a prospective controlled framework.
在胰十二指肠切除术（PD）期间，术中风险分层的重要性日益增加。主胰管（MPD）壁尤为重要，因为它是吻合缝线锚定的要素。本研究旨在描述一种新的胰管内超声（IWU）在 PD 中的安全性、可行性和可重复性。
一项前瞻性研究纳入了 58 例行 PD 并将 MPD 与空肠吻合的患者。在重建阶段之前，使用直径为 1.7 毫米的径向超声探头对残余胰头进行完整的 IWU，以确定吻合部位的 Wirsung 厚度（WT）。
没有与 IWU 相关的并发症报告。MPD 的中位 WT 为 1.1 毫米（标准差 0.2）。术后胰瘘（POPF）、主要并发症和死亡率分别为 17%、5%和 0%。
在 PD 中使用 IWU 具有安全性和可行性。IWU 是一种新的工具，旨在确定 MPD 的结构特征，这些特征可能会影响胰腺吻合的手术策略。在前瞻性对照框架内，需要进一步验证并与当前的标准护理进行比较分析。
