CLIP method (preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery) reduces intraoperative bleeding during pancreaticoduodenectomy
CLIP method (preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery) reduces intraoperative bleeding during pancreaticoduodenectomy
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DOI：
10.1007/s00268-007-9305-y
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发表时间：
2008-01-01
影响因子：
2.6
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
--
作者：
Kawai, Manabu;Tani, Masaji;Yamaue, Hiroki
背景以前没有报道前瞻性地讨论减少胰腺十二指肠切除术(PD)术中出血的手术方法。我们建立了术前CT图像评估的结扎胰头十二指肠下动脉(IPDA)的方法(CLIP)，该方法利用术前三维CT图像在术中准确地探测IPDA根部，并在分离胰头之前结扎IPDA。方法2003年10月至2005年5月，在和歌山医科大学附属医院施行经典式腹膜透析48例，2005年6月至2006年9月行夹夹式腹膜透析48例。结果夹闭术中出血量明显少于传统腹膜外固定术(867ml比728ml，P=0.026)。此外，夹闭法的手术时间、红细胞输注(单位)和红细胞输注均显著少于经典PD(p=0.033，0.042，0.014)。术前3D-CT测量值(37.9±-8.9 mm)与术中测量结果(38.0±8.8 mm)比较，SMA至IPDA根部长度差异无统计学意义(P=0.6283)。结论夹闭法是减少PD术中出血的有效方法。
Background No previous reports have prospectively discussed an operative approach to reducing intraoperative bleeding during pancreaticoduodenectomy (PD). We have established the preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery (IPDA) method (CLIP), which uses a preoperative three-dimensional computed tomographic (3D-CT) image to precisely detect the IPDA root intraoperatively and ligates the IPDA before the pancreas head is isolated. The aim of this study was to clarify whether the new operative approach reduces intraoperative bleeding compared with classical PD.Method Between October 2003 and May 2005, classical PD was performed (n = 48), and from June 2005 to September 2006, PD with the CLIP method was prospectively performed (n = 48) at Wakayama Medical University Hospital. The perioperative status of the patients in the two groups, including intraoperative bleeding, was compared.Results Median intraoperative bleeding in patients with the CLIP method was significantly reduced compared with classical PD (867 ml versus 728 ml; p = 0.026). Moreover, operative time, red blood cell transfusion (units), and red blood cell transfusion in patients with the CLIP method were significantly reduced compared with classical PD (p = 0.033, 0.042, 0.014, respectively). There were no differences in length from the SMA to the IPDA root when the preoperative measurement by 3D-CT image (37.9 +/- 8.9 mm) and the intraoperative findings (38.0 +/- 8.8 mm) were compared (p = 0.6283).Conclusions The CLIP method is a useful and reliable operative technique for reducing intraoperative bleeding in PD.