一针法胰肠吻合用于腹腔镜胰十二指肠切除术多中心研究

Single-stitch pancreatic duct suture for pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy:A multiple center prospective study

目的总结一针法胰肠吻合用于腹腔镜胰十二指肠切除术的经验,探讨其临床推广价值。方法回顾性分析2016年4月至2018年3月浙江大学医学院附属邵逸夫医院普外科、吉林大学附属第一医院肝胆胰外二科、河北医科大学第二医院肝胆胰外科、山东省立医院肝胆胰外科、浙江省人民医院肝胆胰外科实施腹腔镜胰十二指肠切除术的412例病人的临床资料,术中胰消化道重建均采用一针法胰肠吻合。结果 412例病人中,403例顺利完成手术,中转开放手术9例(2.2%)。胰肠吻合时间为(32.2±7.6)mins,手术时间为(353.9±104.8)mins,术中出血量为(327.2±362.3)mL。术后并发症包括:胰生化漏42例(10.2%),B级胰瘘25例(6.1%),C级胰瘘4例(1.0%),胆瘘25例(6.1%),术后出血23例(5.6%),腹腔感染9例(2.2%),胃排空障碍22例(5.3%),肺部感染11例(2.7%)。二次手术18例(4.4%)。术后30 d内死亡7例(1.7%)。术后住院时间为(18.6±10.6)d。术后病理学检查结果:胰头导管腺癌121例(29.4%)、胆管下端癌95例(20.1%)、十二指肠乳头癌47例(11.4%)、壶腹部癌42例(10.2%)、十二指肠腺癌21例(5.1%)、胰腺实性假乳头状瘤16例(3.9%)、胰腺神经内分泌肿瘤16例(3.9%)、胰腺导管内乳头状黏液瘤15例(3.6%)、慢性胰腺炎8例(1.9%)、其他31例(7.5%)。结论一针法胰肠吻合应用于腹腔镜胰十二指肠切除术胰消化道重建,不仅安全有效,而且操作简便,值得进一步研究和推广应用。

Objective To investigate the role of Single-stitch pancreatic duct suture for pancreaticojejunostomy technique （SSPJ） in laparoscopic pancreaticoduodenectomy （LPD）. Methods Between April 2016 and March 2018,the clinical data of patients underwent LPD in Sir Run Run Shaw Hospital of Zhejiang University,Frist clinical hospital of Jilin university,Second Affiliated Hospital of Hebei Medical University,Shandong Provincial Hospital,and Zhejiang provincial people’s hospital were collected prospectively. All patients underwent LPD using SSPJ technique. Results All patients underwent laparoscopic procedure. 9 patients （2.2%） conversed to open operation. The mean time for SSPJ was（32.2±7.6）min. The mean operation time was （353.9±104.8） min. The mean estimated blood loss was （327.2±362.3）mL. Postoperative complications included：42 patients（10.2%） had Biochemical leak,25 patients（6.1%） had pancreatic fistula grade B,4 patients（1.0%） had pancreatic fistula grade C,25 cases（6.1%） had bile leakage,23 patients （5.6%）had postoperatively bleeding,22 cases （5.3%）had delayed gastric empty,9 cases（2.3%） had intra-abdominal infection and 11 cases（2.7%） had pulmonary infection postoperatively. 18 patients need re-operation,7 patients（1.1%）died within 30 days postoperative. The mean postoperative hospital stay is （18.6±10.6）d. Pathologic results showed pancreatic ductal adenocarcinomas in 121 cases（29.37%）,distal bile duct carcinomas in 95 cases（20.06%）,Carcinoma of duodenal papilla in 47cases（11.4%）,ampullary tumors in 42 cases（10.2%）,duodenal carcinoma in 21 cases（5.1%）,solid pseudopapillary tumor of pancreas in 16 cases（3.9%）,intra-ductal papillary mucinous neoplasms in 15 cases（3.6%）,neuroendocrine tumors in 16（3.9%） patient and 31 cases with other diagnosis. Conclusion Our results show that SSPJ is a simple,safe and feasible laparoscopic pancreaticojejunostomy technique,which worth to be popularized.