"变径可测量胰腺导管"在腹腔镜胰十二指肠切除术中的应用

Clinical application of " variable diameter measurable pancreatic duct" in laparoscopic pancreaticoduodenectomy

目的评估"变径可测量胰腺导管"在腹腔镜胰十二指肠切除术(LPD)中的安全性和有效性。方法回顾性分析2019年7月至2020年7月期间在河北医科大学第二医院肝胆外科采用"洪氏一针法"胰管空肠吻合方式行LPD患者的临床资料,共147例。依据患者胰肠吻合所用导管类型分为两组:应用普通胰腺导管的患者作为普通组(n=61);应用"变径可测量胰腺导管"的患者作为变径组(n=86)。对比分析患者围手术期资料及术后各并发症发生情况。结果147例患者中,男性89例,女性58例,年龄(56.7±1.5)岁。两组患者的年龄、性别、体质量指数间差异无统计学意义(P>0.05)。变径组胰体部断面胰管直径(3.2±0.1)mm,胰管内置管深度(4.7±0.2)cm,普通组则无法准确测量。变径组胰瘘发生率显著低于普通组[2.32%(2/61)比11.47%(7/86)],差异具有统计学意义(P=0.023)。结论"变径可测量胰腺导管"在LPD的应用中安全、有效。

Objective To evaluate the safety and effectiveness of clinical application of"variable diameter measurable pancreatic duct"in laparoscopic pancreaticoduodenectomy(LPD).Methods A retrospective study was conducted at the Second Hospital,Hebei Medical University Liver Surgical Team from July 2019 to July 2020 using the"HongShi single stitch"method of pancreatic duct to jejunum anastomosis on 147 patients who underwent LPD.According to the type of pancreatic duct,the patients were divided into having normal pancreatic ducts(the normal group,n=61)and those having"variable diameter measuring pancreatic duct"(the variable diameter group,n=86).The perioperative data and postoperative complications were compared and analyzed.Results There were 89 males and 58 females,aged(56.7±1.5)years.There were no significant differences in age,gender and body mass index between groups(P>0.05).For the variable diameter group,the diameter of the divided pancreatic stump was(3.2±0.1)mm,and the depth of internal pancreatic duct stenting was(4.7±0.2)cm.However,it could not be measured accurately in the normal group.The incidence of postoperative pancreatic fistula rate was significantly lower in the variable diameter group than the normal group[2.32%(2/61)vs.11.47%(7/86),P=0.023].Conclusion The variable diameter measurement of pancreatic duct was safe and effective in choosing patients to undergo LPD.