Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct
Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct
复制标题
埋入式胰空肠吻合术用于单纯腹腔镜胰十二指肠切除术治疗非扩张胰管
DOI：
10.1007/s00464-016-4805-1
复制
发表时间：
2017-04-01
影响因子：
3.1
通讯作者：
Qin, Renyi
中科院分区：
文献类型：
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作者：
Wang, Min;Xu, Simiao;Qin, Renyi
后方LPD被谨慎地认为是可行和安全的切除和重建。然而，残胰的吻合仍然被认为是LPD在一般实践中传播的关键障碍。方法自2014年7月至2015年6月，对52例胰管未扩张患者行胰管空肠吻合术，并对其安全性和可靠性进行评价。采用经胰腺带锁褥式缝合进行改良的导管-粘膜PJ技术，称为埋藏导管-粘膜PJ。结果52例LPD术后胰管均未扩张（1-3 mm）。平均手术时间为4.6 h（范围：3.5-8.3 h），中位吻合时间为37 min（范围：24-53 min）。手术死亡率为0，并发症为21.2%（n = 11），包括出血（n = 3，5.8%），胆瘘（n = 1，1.9%），肺部感染（n = 1，1.9%），胃排空延迟2例（3.8%），胆瘘或PF形成引起的腹腔脓肿2例（3.8%），POPF 2例（3.8%）。根据国际胰瘘研究组（International Study Group on Pancreatic Fistula.Conclusions）的分类，2例患者发生胰瘘（1例A型，1例B型），该技术是一种简单、安全的胰管重建术，尤其适用于胰管未扩张的患者。
Backround LPD has been cautiously regarded as feasible and safe for resection and reconstruction. However, anastomosis of the remnant pancreas is still thought to be a critical obstacle to the dissemination of LPD in general practice. This study presents a new technique of pancreaticojejunostomy for nondilated pancreatic duct and evaluates its safety and reliability.Methods From July 2014 to June 2015, a total of 52 patients underwent LPD with the new technique. A modified technique of duct-to-mucosa PJ was performed with transpancreatic interlocking mattress sutures, named the imbedding duct-to-mucosa PJ. Then the morbidity and mortality was calculated.Results This technique was applied in 52 patients after LPD all with nondilated pancreatic duct (1-3 mm). The mean operation time was 4.6 h (range, 3.5-8.3 h) and the median time for the anastomosis was 37 min (range, 24-53 min). Operative mortality was zero, and morbidity was 21.2 % (n = 11), including hemorrhage (n = 3, 5.8 %), biliary fistula (n = 1, 1.9 %), pulmonary infection (n = 1, 1.9 %), delayed gastric emptying (n = 2, 3.8 %), abdominal abscess caused by biliary fistula or PF formation (n = 2, 3.8 %), and POPF (n = 2, 3.8 %). Two patients developed a pancreatic fistula (one type A, one type B) classified according to the International Study Group on Pancreatic Fistula.Conclusions The described technique is a simple and safe reconstruction procedure after LPD, especially for patients with nondilated pancreatic duct.