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机器人胰十二指肠切除术中高风险吻合的实用方法

Practical Approaches to High-Risk Anastomoses in Robotic Pancreatoduodenectomy.

作者信息

Marcucci Francesca, Carillo Giovanna, Sánchez-Velázquez Patricia, Garcia-Picazo Alberto, Burdio Fernando, Ielpo Benedetto

机构信息

Hepato‑Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Pompeu Fabra University, Barcelona, Spain.

出版信息

Ann Surg Oncol. 2025 Aug;32(8):5717-5719. doi: 10.1245/s10434-025-17402-w. Epub 2025 May 6.

DOI:10.1245/s10434-025-17402-w
PMID:40329135
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12222224/
Abstract

BACKGROUND

Pancreatoduodenectomy (PD) is performed for the treatment of pancreatic head and periampullary tumors and is associated with relatively high postoperative morbidity and mortality. Traditionally conducted as open surgery, PD has evolved with the advent of minimally invasive techniques, including robotic-assisted approaches.

RESULTS

As reported in the literature, minimally invasive PD is becoming a safe and effective alternative surgical approach. Clinically relevant postoperative pancreatic complications, such as fistulas and hemorrhage, remain among the most challenging issues after PD, particularly in high-risk cases. There are several maneuvers that may reduce their incidence and mitigate their postoperative clinical impact.

CONCLUSIONS

In this video, we describe strategies implemented at our center for high-risk PD cases, including some key tips and tricks.

摘要

背景

胰十二指肠切除术(PD)用于治疗胰头和壶腹周围肿瘤,术后发病率和死亡率相对较高。传统上,PD是通过开放手术进行的,随着微创技术的出现,包括机器人辅助手术方法,它也在不断发展。

结果

如文献报道,微创PD正成为一种安全有效的替代手术方法。临床上相关的术后胰腺并发症,如瘘和出血,仍然是PD术后最具挑战性的问题之一,尤其是在高危病例中。有几种操作可能会降低其发生率并减轻其术后临床影响。

结论

在本视频中,我们描述了我们中心针对高危PD病例实施的策略,包括一些关键技巧。

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本文引用的文献

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High-Risk Biliary Anastomosis During Robotic Pancreaticoduodenectomy: Initial Experience with Biodegradable Biliary Stent.机器人胰十二指肠切除术中的高风险胆肠吻合:可生物降解胆道支架的初步经验。
Medicina (Kaunas). 2024 Nov 1;60(11):1798. doi: 10.3390/medicina60111798.
2
Hepatobiliary anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks.肝胆吻合口漏:关于漏的定义、分级系统及后果的叙述性综述
Transl Gastroenterol Hepatol. 2024 Sep 13;9:70. doi: 10.21037/tgh-24-9. eCollection 2024.
3
Minimally invasive pancreatic anastomosis after pancreaticoduodenectomy: multi-institutional step by step video description of the technique.
胰十二指肠切除术后的微创胰肠吻合术:多机构该技术的分步视频描述
Updates Surg. 2023 Jan;75(1):255-259. doi: 10.1007/s13304-022-01389-0. Epub 2022 Nov 12.
4
Pancreatoduodenectomy with or without prophylactic falciform ligament wrap around the hepatic artery for prevention of postpancreatectomy haemorrhage: randomized clinical trial (PANDA trial).胰十二指肠切除术联合或不联合预防性肝动脉镰状韧带包裹预防胰十二指肠切除术后出血:随机临床试验(PANDA 试验)。
Br J Surg. 2021 Dec 17;109(1):37-45. doi: 10.1093/bjs/znab363.
5
Robotic versus standard open pancreatectomy: a propensity score-matched analysis comparison.机器人辅助与标准开放性胰腺切除术:倾向评分匹配分析比较
Updates Surg. 2019 Mar;71(1):137-144. doi: 10.1007/s13304-018-0529-1. Epub 2018 Mar 26.
6
The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After.国际研究小组(ISGPS)术后胰瘘定义与分级的2016年更新:11年后
Surgery. 2017 Mar;161(3):584-591. doi: 10.1016/j.surg.2016.11.014. Epub 2016 Dec 28.
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J Am Coll Surg. 2013 Jan;216(1):1-14. doi: 10.1016/j.jamcollsurg.2012.09.002. Epub 2012 Nov 2.