中国腹腔镜胰十二指肠切除术20年胰肠重建术式变迁与未来发展

Laparoscopic pancreaticoduodenectomy over a 20-year period in China-Evolvement of reconstruction following pancreaticojejunostomy

近20年来,腹腔镜胰十二指肠切除术在中国发展迅速,在很多中心已经成为一种常规手术。胰肠吻合重建是决定腹腔镜胰十二指肠切除术成败的关键步骤。随着微创外科技术的发展,种类众多的胰肠吻合方式也应运而生。每种胰肠吻合方式均有其优缺点和适用人群,胰管对空肠黏膜吻合及其改良方式成为主流选择,但尚无任何一种方式能完全避免胰瘘的发生。在临床实践中,综合考虑患者的实际情况、术者熟练程度以及术中具体情况,选择个体化的胰肠吻合方式并提高吻合质量,才是减少术后胰瘘发生的关键。

In the past 20 years,laparoscopic pancreaticoduodenectomy(LPD)has developed rapidly in China and has become a routine operation in many centers.Pancreaticojejunostomy is a key step in LPD.A wide variety of pancreaticojejunostomy have emerged with the development of minimally invasive surgery.Each type of pancreaticojejunal anastomosis has its advantages and disadvantages as well as its suitable population.Duct to mucosal anastomosis and its improved methods have become the mainstream choices,but none of them can completely avoid the occurrence of pancreatic fistula.In clinical practice,the key to reduce the occurrence of postoperative pancreatic fistula is to select individualized pancreaticojejunostomy and improve the anastomosis quality by comprehensively considering the actual situation of the patient,the proficiency of the operator and the specific situation during the operation.