Gong Shicheng, Li Shijia, Liang Yuhang, Zuo Xiao, Huo Chenglong, Cheng Nuo, Wang Shuai
Department of Pancreatic and Biliary Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, China.
Gland Surg. 2024 Nov 30;13(11):2068-2077. doi: 10.21037/gs-24-316. Epub 2024 Nov 26.
There is no uniform conclusion as to whether internal or external drainage of the supporting duct is more clinically effective, especially in laparoscopic pancreaticoduodenectomy (LPD) which has not yet been reported in clinical studies. This study aimed to investigate the efficacy of external versus internal pancreatic duct drainage during LPD performed in a low-flow center at the beginning of the learning curve.
The clinical data of a total of 73 cases of patients who underwent LPD between January 2022 and June 2024 were retrospectively analyzed. Forty-eight cases performed by doctors from Jingzhou Hospital Affiliated to Yangtze University were considered as not having passed the early stages of the learning curve, and 25 cases performed by the invited team with rich LPD experience were considered as having passed the early stages of the learning curve. According to whether they had passed the early stages of the learning curve or not and the method of pancreatic duct drainage used, 73 patients were divided into the external drainage group (EDG) that did not pass the early stages of the learning curve (n=24), the internal drainage group (IDG) that did not pass the early stages of the learning curve (n=24), and the IDG that passed the early stages of the learning curve (n=25). The EDG was compared with the two IDGs in terms of complication rates and other procedure-related indicators.
The total pancreatic fistulae incidence rate of the whole group was 16.4% (12/73), and the incidence of pancreatic fistulae was significantly lower in the EDG that did not pass the early stages of the learning curve (8.3%) than in the IDG that did not pass the early stages of the learning curve (33.3%), with statistically significant difference (P=0.03); the incidence of pancreatic fistulae was slightly higher in the EDG that did not pass the early stages of the learning curve (8.3%) than in the IDG that passed the early stages of the learning curve (8.0%), with statistically not significant difference (P>0.99). The incidence of biliary fistulae in the EDG that did not pass the early stages of the learning curve (0.0%) was lower than that in the IDG that did not pass the early stages of the learning curve (25.0%), and the difference was statistically significant (P=0.02). The differences in other complications between the EDG and the two IDGs were not statistically significant.
External pancreatic duct drainage is more helpful in reducing the incidence of postoperative pancreatic fistulae, more conducive to the safe passage of the operator through the initial stages of the LPD learning curve, more suitable for use in the development of LPD in low-volume centers.
关于支撑导管的内引流或外引流在临床上哪种更有效，尚无统一结论，尤其是在腹腔镜胰十二指肠切除术（LPD）中，临床研究尚未见相关报道。本研究旨在探讨在学习曲线初期于低流量中心进行的LPD中，胰管外引流与内引流的疗效。
回顾性分析2022年1月至2024年6月期间共73例行LPD患者的临床资料。长江大学附属荆州医院医生实施的48例被视为未度过学习曲线早期阶段，受邀的有丰富LPD经验团队实施的25例被视为度过学习曲线早期阶段。根据是否度过学习曲线早期阶段及所采用的胰管引流方法，将73例患者分为未度过学习曲线早期阶段的外引流组（EDG，n = 24）、未度过学习曲线早期阶段的内引流组（IDG，n = 24）和度过学习曲线早期阶段的内引流组（n = 25）。比较EDG与两个IDG在并发症发生率及其他手术相关指标方面的差异。
全组胰瘘总发生率为16.4%（12/73），未度过学习曲线早期阶段的EDG组胰瘘发生率（8.3%）显著低于未度过学习曲线早期阶段的IDG组（33.3%），差异有统计学意义（P = 0.03）；未度过学习曲线早期阶段的EDG组胰瘘发生率（8.3%）略高于度过学习曲线早期阶段的IDG组（8.0%），差异无统计学意义（P > 0.99）。未度过学习曲线早期阶段的EDG组胆瘘发生率（0.0%）低于未度过学习曲线早期阶段的IDG组（25.0%），差异有统计学意义（P = 0.02）。EDG与两个IDG在其他并发症方面的差异无统计学意义。
胰管外引流更有助于降低术后胰瘘发生率，更有利于术者安全度过LPD学习曲线初期阶段，更适用于低容量中心开展LPD。
