Maharjan Dhiresh Kumar, Maharjan Prabir, Limbu Yugal, Ghimire Roshan, Thapa Prabin Bikram
GI and General Surgery, Kathmandu Medical College and Teaching Hospital, Kathmandu, Bagmati, Nepal.
Department of GI and General Surgery, Kathmandu Medical College and Teaching Hospital, Kathmandu, Central Development Region, Nepal.
BMJ Surg Interv Health Technol. 2025 Jun 12;7(1):e000318. doi: 10.1136/bmjsit-2024-000318. eCollection 2025.
Post-pancreatectomy acute pancreatitis (PPAP) has been a well-defined entity by the International Study Group of Pancreatic Surgery. Underlying cause may be hypoperfusion at remnant stump of pancreas, which has been linked with additional post-pancreatectomy complications like postoperative pancreatic fistula. The primary goal was to assess the vascularity of remnant pancreas utilizing indocyanine green with near-infrared fluorescence. Indocyanine Green could aid in objectively mitigating hypoperfusion status of the pancreatic stump.
Hospital-based descriptive study conducted as per the revised Strengthening the Reporting of Observational Studies in Epidemiology guidelines between 1 August 2022 and 2 August 2023.
This study was conducted in tertiary care centers of Kathmandu.
All 43 participants who underwent pancreaticoduodenectomies were included who completed the study.
Blood supply to the remnant of the pancreas during pancreaticoduodenectomy was assessed utilizing indocyanine green, capturing distinct arterial, venous, and port venous phases, which were analyzed after 10 to 15 s of administration.
In three instances, indocyanine green dye revealed unequal vascular supply at the pancreatic remnant, requiring adjustments to the margins before completing the anastomosis of the remnant pancreas and the jejunum.
PPAP was noticed in eight patients (18.6%), among which five patients (11.6 %) had postoperative hyperamylasemia, and three had grade B PPAP. The outcomes revealed that in the 40 patients with adequate perfusion, PPAP occurred in seven patients(16.3%), and grade B clinically relevant postoperative pancreatic fistula occurred in one patient. In contrast, among the three patients with inadequate perfusion, after revision of the pancreatic margin, PPAP was observed in one patient, and none of them had clinically relevant post-operative pancreatic fistula.
Postoperative acute pancreatitis, ultimately exhibiting the possibility of postoperative pancreatic fistula, must be monitored with vigilance. While several elements contribute to fistula formation, ensuring sufficient vascular supply at the pancreatic remnant using indocyanine green may alleviate presumed PPAP and associated complications. The dye could aid in enhancing surgical outcomes following pancreaticoduodenectomy.
胰十二指肠切除术后急性胰腺炎（PPAP）已被国际胰腺外科研究组明确界定。其潜在原因可能是胰腺残端灌注不足，这与胰十二指肠切除术后的其他并发症如术后胰瘘有关。主要目标是利用吲哚菁绿和近红外荧光评估残余胰腺的血管情况。吲哚菁绿有助于客观缓解胰腺残端的灌注不足状态。
根据修订后的《加强流行病学观察性研究报告规范》指南，于2022年8月1日至2023年8月2日进行的一项基于医院的描述性研究。
本研究在加德满都的三级护理中心进行。
所有43例行胰十二指肠切除术且完成研究的参与者均被纳入。
在胰十二指肠切除术中，利用吲哚菁绿评估胰腺残余部分的血液供应，捕捉不同的动脉期、静脉期和门静脉期，给药10至15秒后进行分析。
在三例病例中，吲哚菁绿染料显示胰腺残余部分的血管供应不均，需要在完成残余胰腺与空肠吻合之前调整切缘。
8例患者（18.6%）出现PPAP，其中5例患者（11.6%）术后出现高淀粉酶血症，另外3例为B级PPAP。结果显示，在40例灌注充足的患者中，7例患者（16.3%）发生PPAP，1例患者发生B级临床相关术后胰瘘。相比之下，在3例灌注不足的患者中，调整胰腺切缘后，1例患者出现PPAP，且均未发生临床相关术后胰瘘。
必须警惕术后急性胰腺炎，其最终可能导致术后胰瘘。虽然有几个因素促成瘘的形成，但使用吲哚菁绿确保胰腺残余部分有足够的血管供应可能会减轻假定的PPAP及相关并发症。该染料有助于提高胰十二指肠切除术后的手术效果。
