Hem-o-lok® 夹在胰十二指肠切除术中用于结扎胃十二指肠动脉的作用。

Usefulness of Hem-o-lok® clips to ligate the gastroduodenal artery in pancreatoduodenectomy.

机构信息

Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan.

出版信息

HPB (Oxford). 2024 Dec;26(12):1521-1527. doi: 10.1016/j.hpb.2024.08.014. Epub 2024 Sep 3.

DOI:10.1016/j.hpb.2024.08.014

Abstract

BACKGROUND/PURPOSE: Post-pancreatectomy hemorrhage (PPH) is a fatal complication of pancreatoduodenectomy. When complicated by a pancreatic fistula, pancreatic juice contacting the artery may form a pseudoaneurysm and cause arterial bleeding. We used Hem-o-lok® clips to prevent damage to the outer wall of the gastroduodenal artery (GDA). This study evaluated the usefulness of using Hem-o-lok® clips to ligate the GDA stump to prevent PPH.

METHODS

Overall, 468 patients who underwent PD at our hospital were included. Before July 2020, we ligated the GDA stump using the knot-tying method, which involves double ligation. After July 2020, the GDA stump was double clipped using a 10-mm Hem-o-lok® clip to the residual side without tension on the GDA. Propensity score matching was used to compare cases of pancreatic fistulas that underwent clipping vs. knot-tying.

RESULTS

Propensity score matching resulted in 37 patients in each group. PPH occurred in 12 (16.4%) and 4 (6.9%) patients in the knot-tying and clipping groups, respectively. PPH from the GDA stump occurred in eight (11.0%) and one (1.7%) patient in the knot tying and clipping groups, respectively (P = 0.044).

CONCLUSIONS

Hem-o-lok® clips are safe to apply on the GDA stump during pancreatoduodenectomy to prevent PPH.

摘要

背景/目的：胰十二指肠切除术后出血（PPH）是胰十二指肠切除术后的一种致命并发症。当并发胰瘘时，接触动脉的胰液可能会形成假性动脉瘤并导致动脉出血。我们使用 Hem-o-lok®夹来防止胃十二指肠动脉（GDA）外壁受损。本研究评估了使用 Hem-o-lok®夹结扎 GDA 残端以预防 PPH 的有效性。

方法

共有 468 例在我院接受 PD 的患者被纳入本研究。在 2020 年 7 月之前，我们采用双结扎的方法结扎 GDA 残端，即在 GDA 上进行双结扎。2020 年 7 月之后，使用 10mm 的 Hem-o-lok®夹对 GDA 残端进行双夹闭，避免 GDA 残留侧的张力。采用倾向评分匹配法比较夹闭组和结扎组的胰瘘病例。

结果

倾向评分匹配后，每组各有 37 例患者。结扎组有 12 例（16.4%）和 4 例（6.9%）患者发生 PPH，夹闭组分别有 12 例（16.4%）和 4 例（6.9%）患者发生 PPH。结扎组有 8 例（11.0%）和 1 例（1.7%）患者发生 GDA 残端 PPH，夹闭组分别有 8 例（11.0%）和 1 例（1.7%）患者发生 GDA 残端 PPH（P=0.044）。