磁吻合技术在腹腔镜胰十二指肠切除中应用的初步经验

Initial results in the use magnetic compression anastomosis in laparoscopic pancreaticoduodenectomy

目的探讨磁吻合技术在腹腔镜胰十二指肠切除术(laparoscopic pancreatoduodenectomy,LPD)中应用的可行性和安全性。方法回顾分析2018年5月至2019年9月于西安交通大学第一附属医院肝胆外科接受LPD+磁吻合消化道重建的7例患者资料,其中男性6例,女性1例,患者中位年龄63(56~83)岁。观察指标包括磁吻合装置型号、胆肠或胰肠磁吻合操作时间、手术相关参数、术后并发症、磁吻合形成时间及磁体排出时间。结果7例患者均顺利完成LPD,包括7例胆肠磁吻合和2例胰肠磁吻合,中位手术时间340(310~450)min。胆肠磁吻合环中位直径10(9~12)mm,胆肠磁吻合中位时间11(8~16)min;2例胰肠磁吻合环直径均为5 mm,胰肠磁吻合分别耗时12 min、15 min。4例患者出现并发症,包括A级及B级胰瘘各1例、腹腔感染2例、术后胃排空障碍2例及腹腔出血1例,均予保守治疗好转,磁吻合处均无胆、胰瘘发生。2例胰肠磁吻合口于术后24 d、30 d形成。所有患者体内磁体排出体外中位时间为50(40~170)d,中位随访11(4~18)个月,无胆肠或胰肠吻合口狭窄出现。结论LPD术中采用磁吻合完成胆肠或胰肠重建安全、有效。

Objective To study our initial experience on feasibility and safety of magnetic compression anastomosis in laparoscopic pancreaticoduodenectomy(LPD).Methods A retrospective analysis was conducted on the data of 7 patients who underwent LPD with laparoscopic magnetic compression choledochojejunostomy(LMC-CJ)or pancreaticojejunostomy(LMC-PJ)at the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi’an Jiaotong University from May 2018 to September 2019.There were 6 males and 1 female.The median age of patients was 63(56-83)years.Data analyzed included the model of the magnetic anastomosis device,operation time of the LMC-CJ or LMC-PJ,other operation-related parameters,postoperative complications,time to perform magnetic anastomosis,and time of discharge of the magnet from patients’body.Results All 7 patients completed LPD successfully,including 7 LMC-CJ and 2 LMC-PJ.The median operation time was 340(310-450)minutes.The median diameter of the biliary-enteric magnetic anastomosis ring used was 10(9-12)mm,and the median time of the biliary-enteric magnetic anastomosis was 11(8-16)min.The diameter of the pancreaticojejunal magnetic anastomosis ring was 5 mm in the two anastomoses,and the times taken were 12 min and 15 min.Complications occurred in 4 patients,including 1 patient each for grade A and grade B pancreatic fistula,2 patients with abdominal infection,2 patients with postoperative gastric emptying disorder,and 1 patient with abdominal hemorrhage.All patients responded to conservative treatment.There was no biliary or pancreatic fistula at the magnetic anastomoses.Pancreaticojejunostomy functioned at 24 and 30 days after operation.The median time for the magnets to pass out from the body of all patients was 50(40-170)days.The median follow-up was 11(4-18)months.No biliary-enteric or pancreaticojejunostomy stenosis was detected.Conclusion Magnetic compressive anastomosis was simple,feasible,and safe for choledochojejunostomy or pancreaticojejunostomy in LPD.