Greater Omentum Binding: A Simple Technique to Cover the Pancreatic Remnant after Distal Pancreatectomy
Greater Omentum Binding: A Simple Technique to Cover the Pancreatic Remnant after Distal Pancreatectomy
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大网膜捆绑：一种覆盖远端胰腺切除术后残余胰腺的简单技术
DOI：
10.1016/j.jamcollsurg.2014.01.066
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发表时间：
2014
影响因子：
5.2
通讯作者：
Qin Renyi
中科院分区：
文献类型：
--
作者：
Wang Min;Zhu Feng;Peng Feng;Tian Rui;Shi ChengJian;Xu Meng;Li Xu;Wang Xin;Shen Ming;Qin Renyi
我们对2013年5月至2013年10月在华中科技大学同济医学院同济医院胆胰外科研究所接受开放性DP的17例连续患者（9例男性，8例女性）进行了这种新方法。术前告知患者残胰处理方法，并获得所有患者的知情同意。临床病理变量，术前因素（包括年龄和合并症），手术记录，术后住院data.Surgical程序胰腺切除术包括肿瘤，整块DP，淋巴结切除术和脾切除术也进行了恶性疾病的患者。在良性或低度恶性胰腺疾病中，尽可能保留脾脏。将胰腺与肝总动脉、脾总动脉及门静脉系统分离后，双重结扎脾动、静脉并解剖。使用直线型吻合器（1.5- 2.5-mm粗钢丝[Ethicon TL 60]; Ethicon Endo-Surgery，Inc）进行胰腺横断。然后使用经胰腺互锁褥式缝合（4-0聚对二氧环己酮）再次闭合残余胰腺，接近胰腺残余的0.5 cm切割边缘（图1）。标准覆盖程序涉及使用大网膜。首先，展开大网膜，选择厚且完整的部分用于随后与闭合的胰腺残端结合。根据胰腺残端的大小（直径约2 - 3 cm）预设切口长度的荷包缝合（1-0 Vicryl; Ethicon Endo-Surgery，Inc）（图2）。用荷包缝合的大网膜切片覆盖胰腺残端。用两个止血钳固定网膜，剩余缝线位于胰腺残端的上下缘
METHODS Patients We performed this new method on 17 consecutive patients (9 men, 8 women) who underwent open DP between May 2013 and October 2013 at the Institute of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong Scientific and Technological University, China. Patients were informed of the remnant pancreas management method before surgery, and informed consent was obtained from all patients. Clinicopathologic variables, preoperative factors (including age and comorbidities), operative notes, and postoperative hospitalization data were recorded.Surgical procedure Pancreatectomy comprised an oncologic, en bloc DP; lymphadenectomy and splenectomy were also performed in patients with malignant disease. The spleen was preserved whenever possible in benign or low-grade malignant pancreatic diseases. After isolating the pancreas from the common hepatic and splenic arteries and portal venous system, the splenic artery and vein were doubly ligated and dissected. Transection of the pancreas was performed with a linear stapler (1.5-to 2.5-mm heavy wire [Ethicon TL60]; Ethicon Endo-Surgery, Inc). The remnant pancreas was then closed again by use of transpancreatic interlocking mattress stitches (4-0 polydioxanone), approximating the 0.5-cm cut edge of the pancreatic remnant (Fig. 1). The standard coverage procedure involved use of the greater omentum. First, the greater omentum was spread out, and a thick and unbroken part was chosen for subsequent binding to the closed pancreatic remnant. A pursestring suture was preset with the length of the incision based on the size of the pancreatic remnant (approximately 2 to 3 cm in diameter)(1-0 Vicryl; Ethicon Endo-Surgery, Inc)(Fig. 2). The section of the greater omentum with the purse-string suture was used to cover the pancreatic remnant. Two hemostatic forceps were used to fix the omentum, with the remaining stitch in the superoinferior margin of the pancreatic remnant