胆肠、胰肠双磁吻合在胰十二指肠切除术中的应用

Magnamosis for choledochojejunostomy and pancreatojejunostomy in pancreatoduodenectomy:a retrospective clinical study

目的探讨胆肠、胰肠同时使用磁吻合技术在胰十二指肠切除术中的可行性、安全性及有效性。方法从2012年1月至2019年12月9例胰十二指肠切除术中使用磁吻合技术完成胆肠及胰肠重建。收集术前患者一般资料、手术方式、胰肠吻合时间、胆肠吻合形成时间、磁体排出时间、术后并发症等指标。所有患者出院后电话或门诊随访,随访时间至2020年2月。结果9例患者均为恶性肿瘤,术前胆道、胰管均明显增宽,直径分别为16(8~23)mm、7(6~14)mm。所有患者均顺利完成胰十二指肠切除术,其中7例为开腹,2例为腹腔镜。9例患者胰肠吻合使用均传统磁吻合装置,胆肠吻合5例使用传统磁吻合装置,4例使用胆肠磁吻合器。胆肠吻合时间8(5~16)min,胰肠重建的手术时间为10(8~15)min,胆肠吻合与胰肠吻合时间亦无统计学差异(t=-1.6,P>0.05)。术后1例A级胰瘘,保守治愈,无胆瘘。5例胆肠吻合形成时间18(15~33)d,9例胰肠吻合形成时间18(10~33)d。术后经过37(20~60)d,所有患者磁体均排出体外。术后随访15(3~25)个月,胆肠吻合口狭窄1例,经PTCD+球囊扩张治愈。结论对于胆、胰管均扩张的恶性肿瘤行胰十二指肠时,磁吻合技术完成胆肠及胰肠重建简便、省时,术后无明显胆胰瘘发生。

objective To investigate the feasibility,safety and efficacy of magnet compression anastomosis for both choledochojejunostomy(CJ)and pancreatojejunostomy(PJ)in pancreatoduodenectomy(PD).Methods A total of nine patients who received magnomosis for both CJ and PJ in PD in the First Affiliated Hospital of Xi’an Jiaotong University from Jan.2012 to Dec.2019,were enrolled in the this retrospective study.The clinical data were collected,including general information of patients,primary operation,time duration for CJ and PJ,the time for formation of CJ and PJ,the time of magnets expulsed,hospitalization time and postperative complications.All the patients were followed up till Feb.2020 by telephone or outpatients services.Results All the nine patients were malignant tumors,the common bile duct and pancreatic duct were obviously widened,with the diameter of 16 mm(range,8~23 mm)and 7 mm(range,6~14 mm),respectively.The PDs were completed successfully for all the patients,among whom seven received open surgery and two underwent laparoscopic surgery.The traditional magnet device was used in five CJs and nine PJs,while four CJs were performed by CJ magnamosis device.The median duration for CJ and PJ were 8 min(range,5~16 min)and 10 min(range,8~15 min),respectively,and there was no statistical difference in the time cost between CJ and PJ(t=-1.6,P>0.05).Only one case experienced biochemical panreatic fistula after operation,who was cured by conservative ways,and no biliary leakage occured.The stomas were formed after 18 d(range,15~33 d)for five cases of CJ and 18 d(range,10~33 d)for nine cases of PJ,respectively.All the magnets were expulsed after 37 d(range,20~60 d)after operation.After a following up of 15 months(range,3~25 months),only one case of anastomostic stricture for CJ occurred,who were cured by percutaneous transhepatic cholangiodrainage and balloon dilation.Conclusion For patients with both dilated biliary and pancreatic ducts,the magnamosis for both CJ and PJ in PD is simple and time-saving,and no obvious postoperative biliary or pancreatic fistula occur.