腹腔镜胰十二指肠切除术中“洪氏一针法”胰管空肠吻合的临床应用

The role of Hong′ s single-stitch duct to mucosa pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy

目的：探讨腹腔镜胰十二指肠切除术中应用“洪氏一针法”进行胰管空肠吻合的临床效果。方法回顾性分析2016年4月至10月浙江省人民医院肝胆胰外科（33例）和吉林大学第一医院肝胆胰外二科（18例）在腹腔镜胰十二指肠切除术中应用“洪氏一针法”完成胰管空肠吻合术的51例患者资料。男性31例，女性20例，年龄25～86岁，平均（59±11）岁，体重指数18～28 kg／m^2，平均（23.2±4.4）kg／m^2。术前诊断：胰头占位性病变18例、壶腹周围肿瘤26例、胰头主胰管型胰腺导管内乳头状黏液肿瘤3例、十二指肠癌2例、浆液性囊腺瘤2例。结果本组51例患者中，1例联合肠系膜上静脉切除重建。平均手术时间为（307±69）min，远端胰腺断面胰管直径（3.1±1.1）mm，平均胰肠吻合时间（34±5）min，术中平均出血量（170±127）ml。术后并发症：胰瘘12例（23.5％），其中A级9例（17.6％）、B级3例（5.9％）；胆瘘5例（9.8％），胃排空延迟5例（9.8％），肺部感染2例（3.9％），均保守治疗治愈。腹腔内出血1例（2.0％），经再次手术治愈。无死亡病例。术后平均住院时间（16±12）d。术后病理检查结果：胰头导管腺癌20例（39.2％）、非胰头来源壶腹周围癌23例（45.1％）、胰头主胰管型胰腺导管内乳头状黏液肿瘤3例（5.9％）、十二指肠癌2例（3.9％）、浆液性囊腺瘤2例（3.9％），胰头神经内分泌肿瘤1例（2.0％）。结论在腹腔镜胰十二指肠切除术中应用“洪氏一针法”进行胰管空肠吻合所需时间较短，且安全有效。

Objective To investigate the role of “Hong′ s single-stitch duct to mucosa pancreaticojejunostomy（ HSDMP ）” in laparoscopic pancreaticoduodenectomy （ LPD ）. Methods The clinical data including perioperative and short-term outcomes of 51 cases of LPD with HSDMP which performed in Zhejiang Provincial People′s Hospital（33 cases） and Frist Clinical Hospital of Jilin University （ 18 cases） between April and October 2016 were reviewed retrospectively. There were 31 male patients and 20 female patients. The mean age was（59±11）years. Body mass index （BMI） was 18 to 28 kg/m^2 and the average BMI was （23.2±4.4）kg/m^2. Preoperative diagnosis：18 cases with pancreatic mass,26 cases with peri-ampullary tumor, 3 cases with intra.ductal papillary mucinous neoplasms, 2 cases with duodenal carcinoma,2 cases with serous cystadenoma. Results Fifty.one patients accepted LPD using HSDMP. One patient underwent LPD combined with resection of superior mesentery vein. The mean operation time was （307±69）minutes,the mean diameter of pancreatic duct for reconstruction was （3.1±1.1）mm.The mean operation time for HSDMP was （34±5） minutes,the estimated blood loss was （170±127）ml. Twelve cases＆amp;nbsp;（ 23.5%） had pancreatic fistula according to International Study Group definition, including 9 cases （ 17.6%） of grade A and 3 cases （ 5.9%） of grade B.Five cases （ 9.8%） had delayed gastric empty, 5 cases（ 9.8%） had bile leakage and 2 cases （ 3.9%） had pulmonary infection postoperative.All these complications were treated by non.surgical strategies. One patient（ 2.0%） suffered from postoperative intra.abdominal bleeding and recovered after reoperation. Pathologic results showed pancreatic ductal adenocarcinomas in 20 cases（ 39.2%） ,non.pancreatic original peri.ampullary tumors in 23 cases（ 45.1%） , intra.ductal papillary mucinous neoplasms in 3 cases（ 5.9%） ,duodenal carcinoma in 2 cases（ 3.9%） ,serous cystadenoma in 2 cases（3.9%） and neuroendocrine tumors in one case（2.0%）. Conclusions HSDMP could not only reduce the incidence of clinical pancreatic fistula,but also save operation time. It is a feasible and safe method for pancreaticojejunostomy.